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Biomedical subjects

C M Swartz

Publications and source records attributed to C M Swartz.

At least 55 records · Page 3Linked to original sources
PubMed1994

Visually determined high-frequency seizure activity.

The duration of high-frequency electroconvulsive therapy (ECT) seizure activity, the "spike seizure duration," was rated by two experienced clinicians from the paper EEG recording, along with total EEG seizure duration. The spike seizure duration, taken together with other seizure duration measurements, has shown differences between ECT methods of apparently different efficacy, such as unilateral and bilateral ECT. Close correspondence between the raters demonstrated high reliability for the determination of spike seizure duration, with interrater reliability kappa of 0.92 (p < 10(-6), although the raters employed different rules for selecting the end point.

Electroconvulsive Therapy↗
PubMed1994

Asymmetric bilateral right frontotemporal left frontal stimulus electrode placement: comparisons with bifrontotemporal and unilateral placements.

The asymmetric bilateral stimulus electrode placement described by Swartz was used to treat four patients, ages 60, 75, 75, and 80 years, who had previously received electroconvulsive therapy with other placements. After the course, each showed full remission with no overt cognitive dysfunction and no decrement in mini-mental state score. Three patients had shown substantial confusion during previous treatments, one with bifrontotemporal brief pulse and two with sine wave, at least one of whom received unilateral treatment. Remission was maintained at followup 2-4 months later. These cases further suggest that this new placement is clinically useful.

Affective Symptoms↗
PubMed1994

Computer automated versus visually determined electroencephalographic and electromyographic seizure duration.

Seizure durations were determined during electroconvulsive therapy (ECT) by a computer-automated procedure for interpreting electroencephalographic (EEG) and electromyographic (EMG) signals. These seizure durations were compared with durations determined by two experienced clinicians from simultaneous paper recordings of EEG and EMG and with independently recorded observations of cuffed-limb motor movements. The computer EEG seizure end point was programmed as the point where the moving average EEG voltage first fell below the pre-ECT value and remained there for at least 2 s. The computer EMG seizure end point was programmed as the point where the moving average EMG voltage first fell below 200 mV and remained there for at least 2 s. Close correspondence between seizure durations rated from EEG recordings and computer-automated EEG measurements demonstrated validity and high reliability of the computer procedure. Likewise, validity and reliability were demonstrated for motor seizure durations both computer-derived and interpreted from the paper EMG recording by their close correspondence with cuffed-limb motor seizure durations.

Anesthesia↗
PubMed1993

ECT emergence agitation and methohexital-succinylcholine interaction. Case report.

Two separate methods of preventing post-ECT emergence agitation are increasing the succinylcholine dose to about 1.1 mg/kg and adding a methohexital bolus of about 0.67 mg/kg immediately at seizure end. These methods can work separately and additively without any expectation of diminishing treatment efficacy. A relevant case is described.

Anesthesia Recovery Period↗
PubMed1993

Elevated serum CK in long abstinent cocaine abusers.

In preparation for an exercise program in cocaine abusers maintained abstinent in a hospital setting (average 98.4 days), we measured resting serum creatine kinase (CK). Surprisingly, many were elevated. Further tests confirmed the observation. We measured 19 long abstinent cocaine abusers, 22 abstinent abusers of other substances, and a later group of 26 long abstinent cocaine abusers. While none of the other substance abusers showed elevated serum CK levels, 53 and 31% of the abstinent cocaine groups did (p = .000082 and .00041, respectively). All CK elevations were muscle derived; repeated sampling demonstrated stability. Cocaine abusers' CK showed a bimodal distribution: the lower bell curve approximated controls and the higher bell curve centered above normal range, at 400 U/L. Demographics did not influence the results. With complementary findings of impaired spatial motor performance, these persistent CK elevations suggest that a large minority of cocaine abusers maintain tendencies to coarse motor control and impulsive movements, and perhaps hyperactivity.

Adult↗
PubMed1993

Seizure benefit: grand mal or grand bene?

The adverse stresses and injuries associated with epileptic seizures are prevented routinely when programmed, controlled grand mal seizures are administered. According to the described concepts of clinical benefit, symptoms of brain illnesses that are without substantial neuronal deterioration, but that have a sense of neurotransmitter dysregulation, are candidates for mitigation by administration of programmed seizures. Such symptoms include delirium, dementia, neuroleptic malignant syndrome, movement disorder, psychosis, and depression. Prior to recommending cortical excision for management of offtial complex epilepsy, a course of programmed seizures should be considered routinely.

Electroconvulsive Therapy↗
PubMed1992

Electroconvulsive therapy-induced cortisol release after dexamethasone in depression.

ECT-induced cortisol release was distinctly seen, and fell along a course of ECT in each of 12 inpatient male melancholics (p = 0.00024, binomial), with dexamethasone given to diminish the elevated baseline cortisol levels typically seen in depression. Cortisol release dropped on average by 55% (p = 0.015), from 16.6 +/- 6.8 micrograms/dl (p = 0.000002) with the first ECT to 8.0 +/- 7.7 micrograms/dl (p = 0.000003) after 6 or more ECTs. The fall along the course was larger with unilateral ECT than bilateral ECT (p = 0.042), although significant regardless of electrode placement, suggesting that unilateral ECT tends to lose therapeutic impact along a course in comparison to bilateral ECT.

Aged↗
PubMed1991

Antidepressant effects of high-dose right unilateral electroconvulsive therapy.

In a random-assignment, double-blind, controlled comparison in 38 melancholic men, overall antidepressant potency of high-dose electroconvulsive therapy (378-mC charge) given with right unilateral electrode placement was not significantly different from that with bilateral placement, although there was a trend for faster improvement with bilateral ECT. The suprathreshold character of the stimulus, about 2.5 times the expected seizure threshold, may have contributed to the high efficacy of brief-pulse right unilateral electroconvulsive therapy found in this study.

Adult↗
PubMed1991

Drug dose prediction with flexible test doses.

This article presents the first known practical method to apply one-compartment pharmacokinetic modeling to prediction of doses for drugs from one or more blood-drug concentrations, without requiring approximations or a computer. It should be useful for regulating doses of orally administered CNS drugs whose effects develop over a day or more, e.g., lithium, antidepressants, and anticonvulsants. Pharmacokinetic calculations for sequences of one, two, and three test doses are condensed into graphs that can be rapidly applied for clinical purposes. These graphs account for dose division, blood sampling time, and drug elimination rate; they show that the ratio of the steady-state day-mean drug level to the test-drug blood level is independent of the half-life if the test level is about a day after the last test dose. The calculations show the same value as experimental measurements for the ratio between steady-state serum lithium level and serum lithium level measured after a test dose. A rational strategy for drug-loading doses is discussed.

Central Nervous System Agents↗
PubMed1991

Theophylline reversal of electroconvulsive therapy (ECT) seizure inhibition.

Oral sustained-release theophylline 200-400 mg, given 10 hours prior to electroconvulsive therapy (ECT) increased ECT seizure length in each of eight male patients who had shown unacceptably short seizures. The increase was on average 13.9 (+/- 6.0, SD) sec (p = .00016 by t test; p = .0000034 by exact probability). The absence of unduly prolonged seizures was attributed to previously demonstrated high seizure thresholds and to relatively low concentrations of theophylline. No adverse effects from theophylline were seen.

Aged↗