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Biomedical subjects

A Ebner

Publications and source records attributed to A Ebner.

At least 91 records · Page 5Linked to original sources
PubMed1996

Cerebellar hypometabolism in focal epilepsy is related to age of onset and drug intoxication.

PURPOSE: We wished to investigate the cerebellar depression of regional cerebral glucose metabolism (rCMRGlu) in patients with focal epilepsy. METHOD: In 170 consecutive patients with medically refractory, focal epilepsy the rCMRGlu was measured in cerebellum and brain. RESULTS: rCMRGlu was markedly decreased in both cerebellar hemispheres and slightly in brain. The cerebellum to brain rCMRGlu ratio was significantly decreased in patients with seizure manifestation in infancy, but was normal due to a progressive decrease in brain rCMRGlu in later age. A subgroup of patients with focal epilepsy involving the frontal lobe had a reduced cerebellum/brain rCMRGlu ratio, whereas in patients with mesiotemporal lobe epilepsy (MTLE), the rCMRGlu was decreased to the same degree in cerebellum and brain. The difference in the cerebellum/brain rCMRGlu ratio between the two groups was accounted for by the younger age of the patients with focal epilepsy involving the frontal lobe, however. In another subgroup of patients with a documented history of critical drug intoxications, the cerebellar rCMRGlu was severely decreased, resulting in a significantly reduced cerebellum/brain rCMRGlu ratio. CONCLUSION: Our retrospective study suggests that the cerebellum is particularly vulnerable in infancy to ongoing epileptic activity and high dosage of antiepileptic drugs (AEDs).

Adult↗
PubMed1996

Systematic testing of medical intractability for carbamazepine, phenytoin, and phenobarbital or primidone in monotherapy for patients considered for epilepsy surgery.

PURPOSE: To assess medical intractability in patients considered for restrictive epilepsy surgery. METHODS: Seventy-four patients received single drug treatment with carbamazepine (CBZ), phenytoin (PHT), and either phenobarbital (PB) or primidone (PRM). Medical intractability was established if seizure control was not obtained despite maximum tolerable doses of the drug. In all, 120 single drug treatments were administered with the drugs that has not been administered at maximal doses in monotherapy before the study. RESULTS: Complete seizure control was not achieved in any patient. However, 7 patients (9.5%) had significant seizure reduction of at least 80%. In 4 patients, only the third antiepileptic drug (AED) proved effective. CONCLUSION: The poor result of AED monotherapy in our patients may be attributed to the patients' long-standing chronic epilepsies and high seizure frequencies. Our findings suggest that despite the failure of one or two major AEDs in controlling seizures completely, further single drug treatment may still improve the quality of life in some patients who are candidates for epilepsy surgery.

Adolescent↗
PubMed1996

Topography of interictal glucose hypometabolism in unilateral mesiotemporal epilepsy.

We mapped the regional cerebral glucose metabolism (rCMRGlu) in 20 patients suffering from medically refractory focal epilepsy of either left or right mesiotemporal origin (mTLE) during resting wakefulness. After temporal lobectomy, histology demonstrated hippocampal sclerosis in 18 patients. Pixel-by-pixel comparisons with healthy control subjects showed significant (p < 0.001) depressions of the mean rCMRGlu ipsilateral to the epileptic focus in the mesiotemporal region, including the hippocampus and the parahippocampal gyrus and middle temporal gyrus. Additional remote rCMRGlu depressions occurred bilaterally in the fronto-orbital cortex and ipsilaterally in the posterior insula and the thalamus. Patients with left-sided mTLE had additional rCMRGlu depressions in the left inferior frontal gyrus (Broca's region) and superior temporal gyrus at the parietotemporal junction, whereas corresponding rCMRGlu depressions were not present in patients with right mTLE. Neuropsychological testing showed impaired verbal fluency, verbal intelligence, and verbal memory in the left mTLE patients. Correlations of the specific mean rCMRGlu depressions and the neuropsychological deficits suggest that impaired language functions in patients with left mTLE could result from functional changes beyond the temporal lobe.

Adolescent↗
PubMed1996

Supplementary sensorimotor area seizure and ictal single-photon emission tomography.

Focal tonic seizures [supplementary motor seizures in the terminology of Penfield and Jasper (1) are often difficult to diagnose in terms of this chapter was undertaken to investigate whether ictal single-photon emission CT (SPECT) scanning could contribute to the diagnostic accuracy of this epileptic condition. In 15 patients (mean age, 21.3 years; ranges, 3 to 39 years) suffering from focal tonic seizures as the initial and most prominent seizure type, ictal SPECT scans were obtained after injection of 99mTc HMPAO within 30 seconds after clinical seizure onset. In 6 patients (40%; group I), ictal SPECT scans showed a focal hyperperused area concordant with results of other tests of the preoperative work-up (prolonged EEG/video monitoring, MRI, and positron emission tomography PET) using [18F]fluoro-2-deoxy-D-glucose (18FDG)] In 6 patients (group II), results of the ictal SPECT scans also showed findings of other tests of the clinical work-up. In 3 patients (group III), no ictal hyperperfusion could be observed. Results of the other presurgical tests in groups II and III were not sufficient to identify the seizure onset zone with the certainty needed for surgical resection. Ictal SPECT with HMPAO revealed confirmatory results in 40% of the patients with focal tonic seizures. In the remaining patients, results either were not congruent with other findings or did not show any change at all. This may have a twofold explanation: First (and probably most important), the interval between seizure onset and injection was too long considering the usually short duration of this seizure type, and second, the spatial resolution of SPECT imaging might not be sufficient to reveal a small seizure focus.

Adolescent↗
PubMed1995

Palatal tremor of cortical origin presenting as epilepsia partialis continua.

Palatal tremor (PT) is frequently caused by brainstem lesions. The inferior olive plays a major role in the pathophysiologic mechanisms involved. We report a case of PT of cortical origin presenting as epilepsia partialis continua. EEG showed continuous left frontocentral epileptiform discharges and both single photon emission computed tomography (SPECT) and positron emission tomography (PET) showed focal hypoperfusion and hypometabolism in the corresponding location.

Adolescent↗
PubMed1995

Propagation of interictal epileptic activity in temporal lobe epilepsy.

We recorded interictal spikes with closely spaced scalp electrodes and sphenoidal electrodes in four patients with temporal lobe epilepsy. We used multiple dipole modeling to study the number, three-dimensional intracerebral location, time activity, and functional relationship of the neuronal sources underlying the epileptic spike complexes. In all patients, we found two significant sources generating the interictal spikes which showed considerable overlap in both space and time. Source 1 was located in the mesiobasal temporal lobe and generated a restricted negativity at the ipsilateral sphenoidal electrode and a widespread positivity over the vertex. Source 2 could be attributed to the lateral temporal neocortex and was associated with a relatively restricted negativity at the ipsilateral temporal electrodes and a more widespread positivity over the contralateral hemisphere. The sources were well separated in space, with an average distance of 45 mm between them. The time activities of both sources showed similar biphasic patterns, with the mesial source leading the lateral source by approximately 40 msec, suggesting propagation of interictal epileptic activity from the mesiobasal to the lateral temporal lobe.

Adult↗
PubMed1995

Automatisms with preserved responsiveness: a lateralizing sign in psychomotor seizures.

This is a report of a 1-year prospective study to investigate how often automatisms occur with preserved responsiveness in psychomotor seizures. Responsiveness is usually impaired or lost when automatisms occur during psychomotor seizures. However, there are several anecdotal reports in the literature of patients who have automatisms with preserved responsiveness (APRs). We evaluated 123 patients with temporal lobe epilepsy (57 patients [46%] left-sided, 48 patients [39%] right-sided, and 18 patients [15%] bitemporal) with video/EEG monitoring, testing responsiveness by asking the patient to respond verbally and to follow motor commands. Seven patients (5.6%) had preserved responsiveness in the presence of prominent automatisms (lip smacking, swallowing). In 15 seizures, the responsiveness was adequately tested (3.6 questions per period of automatism). Average seizure duration was 71.6 +/- 14.8 seconds (range, 45 to 100 seconds). Average duration of automatisms was 59.5 +/- 13.5 seconds (range, 40 to 80 seconds). Ictal EEG was localized over the right temporal area in nine seizures, over the right hemisphere in five, and was nonlocalizable in one seizure. APRs never occurred in left-sided psychomotor seizures and occurred in 10% of the right temporal cases. In conclusion, APRs reliably lateralized to the right side in temporal lobe epilepsy.

Adult↗
PubMed1995

Noninvasive electroencephalography and mesial temporal sclerosis.

In this study, preoperative interictal and ictal scalp EEG findings from 24 patients with histologically proven hippocampal sclerosis were analyzed. The electrophysiological findings showed a rather uniform picture: all interictal epileptiform discharges were confined to the temporal region most frequently located at the sphenoidal electrodes. In 50% of the patients contralateral temporal spikes were found, 66% of which were at homologous temporal electrode sites. Initial ictal EEG seizure patterns consisted of rhythmical activity in the delta, theta, or alpha range regionalized over the ipsilateral temporal area or lateralized to the ipsilateral hemisphere. Only 3% of the 173 recorded seizures were found to build up over the side contralateral to the seizure origin. Topographic mapping of temporal spikes in most cases shows a dipolar field with a narrow negative field at the basal temporal area and a widespread positivity at the frontocentroparietal midline, i.e., a vertical dipole. Multiple dipole modeling reveals a spike propagation system between basal and lateral temporal areas. There is evidence that the characteristic initial EEG seizure pattern in mesial temporal lobe epilepsy is of the hypersynchronous form consisting of rhythmic repetitive epileptiform discharges.

Adolescent↗
PubMed1995

[Analysis of postoperative seizure recurrence after 65 temporal lobe partial resections].

Sixty-five patients (aged between 3 years 5 months and 60 years) suffering from medically resistant temporal lobe epilepsy (TLE) were operated on over a period of 33 months in Bethel Epilepsy Center. Thirty-three patients had mesial TLE and 32 patients had TLE of different etiology. The postoperative follow-up lasted 2 years in 30 patients and was on average 13.2 months or at least 8 months in the 35 patients who did not have their last examination 2 years after surgery. Many of the patients (70.9%) were seizure-free; 92.3% achieved a rewarding improvement in seizure frequency and quality of life. Reduction of medication was the cause for relapse in 10 patients, in 6 patients incomplete resection, and in 5 patients the prognosis was not good even before surgery. The cause remained unclear in 4 patients. Freedom from seizures was achieved again by renewed medication or by repeated operation in 10 of 25 patients.

Adolescent↗
PubMed1992

Report of dissection of the internal carotid artery in three cases.

Whereas previously the dissection of arteries leading to the brain was thought to be a rare occurrence, this diagnosis has been found more frequently in the last years as a result of newer imaging methods. Furthermore, in contrast to earlier opinions, there is a rather good prognosis for the recanalisation of the vessels and the restoration of the patient's health. In this paper, three cases with nearly typical constellation of symptoms and beneficial outcome are demonstrated. The related Doppler sonographical findings including duplex scan as well as the angiographical, computer tomographical and magnetic resonance tomography results are reported. It is to be noted that none of the three patients had a severe trauma or belonged to typical risk groups for a spontaneous dissection (Marfan's Syndrome, fibromuscular dysplasia.

Aortic Dissection↗
PubMed1992

Intravesical electrical stimulation--an experimental analysis of the mechanism of action.

The working mechanism of intravesical electrical stimulation (IVES) was evaluated in alpha-chloralose anaesthetized cats and rats. IVES involved a direct activation of bladder mechanoreceptor afferents of the A delta type and as a consequence a central reflex activation of the detrusor. The detrusor response was abolished by bilateral transection of the S1-S3 dorsal roots and by intravesical instillation of lidocaine. The optimal stimulation frequency was 20 Hz. The results offer a theoretical rationale for the use of IVES as treatment of weak detrusor contractility in man.

Animals↗
PubMed1992

Urinary tract infection caused by nontyphoidal Salmonella: report of 30 cases.

Thirty cases of nontyphoidal Salmonella bacteriuria were identified by review of cultures performed at the Mayo Clinic (Minn.) from 1985 to 1989 and at the Federal Public Health Laboratory Innsbruck (Austria) from 1979 to 1989. All patients had symptoms of an acute urinary tract infection (UTI). In 24 cases nontyphoidal Salmonella was the sole pathogen isolated. Only 1 patient presented with concomitant gastroenteritis and 2 had experienced episodes of diarrhea during the weeks before the UTI, but 15 patients had positive stool cultures in the absence of a gastrointestinal illness. Among all positive urine cultures at the Mayo Microbiology Laboratory, 0.015% were positive for nontyphoidal Salmonella; at the Federal Public Health Laboratory Innsbruck, 0.024% of organisms cultured from urine were nontyphoidal salmonellae. In the majority of our patients, Salmonella UTI did not differ clinically from UTI caused by other members of the Enterobacteriaceae; only in renal transplant recipients was the course of genitourinary salmonellosis more serious. While some urinary isolates of nontyphoidal Salmonella may be fecal contaminants, all 30 isolates recovered from urine during this study were considered to be the cause of symptomatic UTI.

Adolescent↗
PubMed1992

[Neurogenic disorders of bladder emptying in closed spinal dysraphism].

Closed (occult) spinal dysraphism, e.g. lipomyelomeningocele, intraspinal lipoma, diastematomyelia, the tethered spinal cord in its various forms and dysgenesis of the sacrum, is often diagnosed late and only symptoms of neurogenic bladder dysfunction are present. A lipomyelomeningocele mostly causes detrusor and sphincter dysfunction, as was the case in five of six children among our patients. However, improvement of neurological and urological symptoms after the operation can only be achieved in about 40%. Four of eight children with diastematomyelia suffered from neurogenic bladder dysfunction; three have meanwhile undergone surgery with complete recovery in one, no relevant change in the second, and worsening in the third. Originally a specific term, the "tethered spinal cord" when associated with spinal dysraphism has taken on a more general meaning. Nowadays this term is not only used for a short, thickened and tight filum terminale, but comprises any pathology, which prevents the spinal cord from ascending. MRI examination of the craniovertebral junction and spinal cord of patients with treated myelomeningocele often reveals secondary pathologic changes: these may be areas of cord atrophy, hydromyelic cavitation or ventral compression from arachnoid cysts with clinical symptoms mostly after the age of 5 years. In these children a changing urodynamic pattern may therefore be caused by such a pathology and is an indication for a thorough neurological examination including MRI. Of all the dysrhaphic states mentioned above, sacral dysgenesis is the most frequent. The sacral osteological anomaly, as a numerical and as a structural anomaly, also determines the neuro-urological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Surgery of post-infarction ventricular septal defect: risk factors for hospital death and long-term results.

From December 1971 to December 1989, 62 patients (pts) 42 males, 20 females, mean age 66 years (yr) 6 months (mth) (range 52-80) were operated upon for post-infarction ventricular septal defect (VSD), (anterior 34, inferior 28). Eight pts (13%), group (G) 1 presented with cardiogenic shock, 19 pts (30.5%), G2 with severe congestive heart failure (CHF); 31 pts (50%), G3 were stable with mild CHF and 4 pts (6.5%), G4 without CHF. Preoperative intra-aortic balloon pumping (IABP) was used in 49 pts (79%). One transplanted pt was excluded from this study. The VSD was closed from 1 day (d) to 5 mth (mean 13 d) after its occurrence. Hospital death (HD) occurred in 23 pts (37.7% +/- 6%). Of 44 incremental risk factors (RF) for HD studied, the preoperative status (PS) was the most significant (P less than 0.01). G1: 87% +/- 12%, G2: 42% +/- 12%, G3: 25.8% +/- 8%, G4: 0%. [table: see text] Non-survivors had a shorter mean delay between VSD occurrence and surgery than survivors: 5.6 +/- 3.7 d vs 18.2 +/- 30 d (P less than 0.05), but this delay was correlated to PS. The follow-up of the 38 early survivors ranges from 2 mth to 14 yr (mean 3 yr, 11 mth); 11 pts died between 45 d and 14 yr. No RF was identified for premature late death. HD included, the actuarial survival rate at 1, 5, 10 yr is: 57% (+/- 7%), 44% (+/- 8%), 30% (+/- 10%), respectively.

Aged↗
PubMed1991

Randomized, double-blind, multicenter trial on treatment of frequency, urgency and incontinence related to detrusor hyperactivity: oxybutynin versus propantheline versus placebo.

Clinical efficacy and adverse effects of oxybutynin and propantheline in the treatment of symptoms related to detrusor hyperactivity were studied in a randomized, controlled, double-blind multicenter trial. Of 169 patients entered into the study 154 were evaluable for statistical analysis. Mean grade of improvement (visual analogue scale) was significantly higher with oxybutynin (58.2%) versus propantheline (44.7%) and placebo (43.4%). Mean bladder volume at first involuntary cystometric contraction was significantly increased with oxybutynin (+57.0 ml.) versus placebo (-9.7 ml.). Mean maximum cystometric bladder capacity was also significantly increased with oxybutynin (+80.1 ml.) versus placebo (+22.5 ml.). Rate of inquired possible adverse effects was significantly higher for oxybutynin (63%) versus propantheline (44%) and placebo (33%). However, only 5 patients dropped out of the study because of adverse effects (oxybutynin 2 and propantheline 3). No serious or lasting adverse effects were encountered with dryness of the mouth being the major complaint. Oxybutynin has statistically significant effects on subjective symptoms and objective urodynamic parameters in patients with detrusor hyperactivity compared to propantheline.

Adolescent↗