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F Rosenow

Publications and source records attributed to F Rosenow.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Early summer meningoencephalitis. Extension of the endemic area to mid-Hessia].

Tick-borne encephalitis (TBE) is the most severe arbovirus disease transmitted by ticks. The mortality of the central European form is 0.7-2%. Active immunisation is recommended for endemic regions. We report on 4 patients with TBE acquired in Middle-Hessen between 1994 and 1997 (2 in 1997). After repeated CSF and serum testing the TBE-specific antibodies were found in all 4 cases. In one case there was also evidence for a prior infection with borrelia burgdorferi. The results of the initial CSF-analysis were atypical in 2 cases (high cell count of 136 cells/mm3, total protein up to 1.5 g/l). The endemic region for TBE has expanded in northern direction into Middle-Hessen, a region in which Lyme borreliosis is also endemic. Thus, true double infections are possible. This and the initially frequently atypical CSF-findings make the differential diagnosis difficult. Therefore, repetitive CSF and blood examinations are recommended.

Adult↗
PubMed1999

Tiagabine-induced absence status in idiopathic generalized epilepsy.

Several medications such as baclofen, amitriptyline and even antiepileptic drugs such as carbamazepine or vigabatrin are known to induce absence status epilepticus in patients with generalized epilepsies. Tiagabine (TGB) is effective in patients with focal epilepsies. However, TGB has also been reported to induce non-convulsive status epilepticus in several patients with focal epilepsies and in one patient with juvenile myoclonic epilepsy. In animal models of generalized epilepsy, TGB induces absence status with 3-5 Hz spike-wave complexes. We describe a 32-year-old patient with absence epilepsy and primary generalized tonic-clonic seizures since 11 years of age, who developed her first absence status epilepticus while treated with 45 mg of TGB daily. Administration of lorazepam and immediate reduction in TGB dosage was followed by complete clinical and electroencephalographic remission. This case demonstrates that TGB can induce typical absence status epilepticus in a patient with primary generalized epilepsy.

Adult↗
PubMed1999

A new epileptic seizure classification based exclusively on ictal semiology.

Historically, seizure semiology was the main feature in the differential diagnosis of epileptic syndromes. With the development of clinical EEG, the definition of electroclinical complexes became an essential tool to define epileptic syndromes, particularly focal epileptic syndromes. Modern advances in diagnostic technology, particularly in neuroimaging and molecular biology, now permit better definitions of epileptic syndromes. At the same time detailed studies showed that there does not necessarily exist a one-to-one relationship between epileptic seizures or electroclinical complexes and epileptic syndromes. These developments call for the reintroduction of an epileptic seizure classification based exclusively on clinical semiology, similar to the seizure classifications which were used by neurologists before the introduction of the modern diagnostic methods. This classification of epileptic seizures should always be complemented by an epileptic syndrome classification based on all the available clinical information (clinical history, neurological exam, ictal semiology, EEG, anatomical and functional neuroimaging, etc.). Such an approach is more consistent with mainstream clinical neurology and would avoid the current confusion between the classification of epileptic seizures (which in the International Seizure Classification is actually a classification of electroclinical complexes) and the classification of epileptic syndromes.

Electroencephalography↗
PubMed1998

[Semiologic classification of epileptic seizures].

Recent advances in epileptology and epilepsy surgery require revision of the currently used International Classification of Epileptic Seizures, which was published 1981. We present a classification of epileptic seizures which is based purely on the clinical seizure semiology. The advantages of a semiological seizure classification are stressed.

Brain Mapping↗
PubMed1998

Staring spells in children: descriptive features distinguishing epileptic and nonepileptic events.

OBJECTIVE: To identify questions sensitive and specific for staring spells of epileptic (absence seizures [AS]) or nonepileptic etiology to increase the yield of history taking. STUDY DESIGN: A questionnaire was completed by parents of 40 children who presented with staring spells. Results from 17 children with AS and 23 with nonepileptic staring (NES) were compared. RESULTS: Features with moderate sensitivity (43% to 56%) but high specificity (87% to 88%) for NES included preserved responsiveness to touch, lack of interruption of playing, and initial identification by a teacher or health professional. These features were more frequent in NES than in AS (P = .013, .016, .030). Body rocking occurred only in NES, but sensitivity was low (13%). Features with high specificity (91% to 100%) for AS included limb twitches, upward eye movements, and urinary incontinence; but sensitivities were low (13% to 35%). CONCLUSION: In children with normal interictal electroencephalography findings and without neurologic disease, staring spells are most likely nonepileptic when parents report preserved responsiveness to touch, body rocking, or initial identification by a teacher or health professional without limb twitches, upward eye movements, interruption of play, or urinary incontinence. In these cases a diagnosis of NES may be confidently applied, with confirmation based on long-term follow-up.

Arousal↗
PubMed1998

Sleep apnoea in endocrine diseases.

The pertinent literature on the prevalence, clinical manifestations and pathogenic mechanisms of sleep apnoea (SA) in endocrine diseases, namely acromegaly, Cushing syndrome, hypothyroidism and diabetes mellitus was reviewed. An increased prevalence is well documented in patients with active and treated acromegaly. While most authors report peripheral obstruction, due to hypertrophy of tongue and pharyngeal tissues, to be the cause of SA in acromegaly, some findings argue for a role of hormone-induced changes of central respiratory control. SA is also more common in hypothyroidism, especially when myxedema is present. The associated edema and myopathy appear to be of pathogenic importance. Thyroxin substitution is frequently effective for the treatment of SA but nCPAP can be necessary initially and in some patients even after remission of clinical signs of hypothyroidism. In Cushing disease and syndrome, parapharyngeal fat accumulation can cause SA, but no epidemiological information is available. In non insulin dependent diabetes (NIDDM), obesity is the common risk factor for both, nocturnal hypoxia and insulin resistance. In IDDM, the development of autonomic neuropathy may predispose to SA. Where treatment of the underlying endocrine disease is unable cure the associated SA, nCPAP is usually the treatment of first choice. More prospective studies are clearly needed to establish prevalences and resolve the controversies regarding pathogenesis.

Cushing Syndrome↗
PubMed1998

Histopathological correlates of epileptogenicity as expressed by electrocorticographic spiking and seizure frequency.

PURPOSE: To study the correlation between histopathology and epileptogenicity, as measured by seizure frequency and electrocorticography (EcoG), in patients with cortical dysplasia (CD) as compared with control patients with gangliogliomas or gliomas. METHODS: The influence of the histopathological classification and the presence of balloon cells in CD on the frequency and extension of five predefined patterns of ECoG spiking, seizure frequency, age of seizure onset and 6-month postoperative outcome were analyzed in 32 patients with focal epilepsy undergoing presurgical evaluation with chronically implanted subdural electrodes. RESULTS: Comparison of patients with CD, gangliogliomas, and gliomas showed that the seizure frequency was greatest in patients with CD and ECoG spiking and was most extensive in patients with gangliogliomas. The onset of epilepsy was earlier in patients with CD and with gangliogliomas. None of these differences was significant. However, in patients with CD, the presence of balloon cells was associated with significantly greater seizure frequency (p=0.009), and a significantly greater number of electrodes recording continuous frequent spiking (p=0.03). The presence of continuous very frequent spiking correlated with the duration of the epilepsy and the number of seizures recorded during monitoring. No significant correlation was detected between histopathology, seizure frequency, or ECoG activity and postoperative outcome, which was relatively favorable in patients with balloon cells. CONCLUSIONS: CD refers to a variety of histopathological patterns associated with different epileptogenicity. In CD, increased clinical and ECoG epileptogenicity correlates with the presence of balloon cells. This finding confirms that balloon cells should be considered in the histopathological classification of CD. The predefined ECoG were not specific for any of the histopathologies investigated.

Adolescent↗
PubMed1998

Semiological seizure classification.

We propose an epileptic seizure classification based exclusively on ictal semiology. In this semiological seizure classification (SSC), seizures are classified as follows: a. Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms. b. Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations. c. "Dialeptic" seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term "dialeptic" seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG). d. Motor seizures are characterized mainly by motor symptoms and are subclassified as simple or complex. Simple motor seizures are characterized by simple, unnatural movements that can be elicited by electrical stimulation of the primary and supplementary motor area (myoclonic, tonic, clonic and tonic-clonic, versive). Complex motor seizures are characterized by complex motor movements that resemble natural movements but that occur in an inappropriate setting ("automatisms"). e. Special seizures include seizures characterized by "negative" features (atonic, astatic, hypomotor, akinetic, and aphasic seizures). The SSC identifies in detail the somatotopic distribution of the ictal semiology as well as the seizure evolution. The advantages of a pure SSC, as opposed to the current classification of the International League Against Epilepsy (ILAE), which is actually a classification of electroclinical syndromes, are discussed.

Electroencephalography↗
PubMed1997

Sequential treatment of Guillain-Barré syndrome with extracorporeal elimination and intravenous immunoglobulin.

Plasma exchange and administration of intravenous immunoglobulin (IgG) are established treatments for Guillain-Barré syndrome (GBS). Elimination of postulated pathogenetic factors by plasma exchange or selective adsorption treatment using affinity-type adsorption columns and subsequent immunomodulation by intravenous IgG may provide a more effective treatment. Forty-five patients with acute GBS were prospectively examined using a clinical score. We treated 11 patients by plasma exchange, 13 patients by selective adsorption using a tryptophan-linked polyvinyl alcohol gel adsorbent, and 21 patients by selective adsorption followed by intravenous IgG. The patients treated sequentially by selective adsorption and intravenous IgG improved significantly better than the patients who received plasma treatment only. The results suggest that sequential treatment of GBS may be superior to plasma treatment alone. The higher cost of combined treatment may be offset by lower overall expenditure.

Acute Disease↗
PubMed1997

Spontaneous intracerebral hemorrhage. Prognostic factors in 896 cases.

To determine the prognostic value of etiology and localization in spontaneous intracerebral hemorrhage, 896 patients with spontaneous intracerebral hemorrhage, as proven by CT, operation or autopsy, were retrospectively studied using univariate data analysis. Etiologies were hypertension in 63.5%, cerebrovascular malformations in 8.5% and abnormal hemostasis in 15% of the patients. In 23% no etiology was determined. Main localizations were cerebral lobes in 49.2%, basal ganglia in 34.4%, brain stem in 6.9%, cerebellum in 6.7% and primary intraventricular in 2.3% of the patients. Ventricular extension was present in 47.0%. A higher case fatality correlated with: 1) ventricular extension (P < 0.00001), 2) increasing age (P = 0.00005), 3) surgical treatment (P = 0.00010), 4) localization in basal ganglia (P = 0.0108) and 5) hypertension as only etiology (P = 0.01471). A lower case fatality was found in patients with cerebrovascular malformations (P = 0.00006) and when the hemorrhage was localized to the cerebral lobes (P = 0.0050). We conclude that etiology and localization are of prognostic value in spontaneous intracerebral hemorrhage.

Adolescent↗
PubMed1996

[Clinically pure motor variant of Guillain-Barré polyneuritis. Report of 3 cases].

We report three patients with severe Guillain-Barré syndrome (GBS). On clinical examination, no sensory deficit was elicited. Electromyography (EMG) and motor nerve conduction velocity (NCV) studies were indicative of an axonal lesion. In two patients, we found total peripheral conduction block without volitional EMG activity. Sensory NCV and cortical median nerve evoked potentials remained normal. Sural nerve biopsy revealed unequivocal alterations of sensory nerve fibers, some in the form of primary demyelination. Therefore, these cases must bei classified as combined motor-sensory syndromes despite the clinical and electrophysiological findings. Although total denervation of the extremity muscles occurred, causing tetraparalysis, this manifestation appears to be attributable to the secondary axonal variant. In contrast to positive reports in literature, immunomodulatory treatment proved ineffective in all three cases.

Aged↗
PubMed1996

Sequential treatment of Guillain-Barré syndrome with extracorporeal elimination and intravenous immunoglobulin.

Plasma exchange (PE) and administration of intravenous immunoglobulin (IgG) are established treatments for Guillain-Barré syndrome (GBS). Elimination of postulated pathogenetic factors by plasma exchange or similar methods, such as selective adsorption (SA) treatment using affinity-type adsorption columns and subsequent immunomodulation by intravenous IgG, may provide a more effective treatment. Forty-five patients with acute GBS were prospectively examined using a clinical score. We treated 11 patients by plasma exchange, 13 with selective adsorption using a tryptophan-linked polyvinyl alcohol gel adsorbent, and a group of 21 patients by selective adsorption followed by intravenous IgG. The patients treated sequentially by selective adsorption and intravenous IgG improved significantly better than the patients who received plasma treatment only. This pilot study suggests that sequential treatment of GBS may be superior to plasma treatment alone. The higher cost of this combined treatment might be offset by shorter hospital stays and lower overall expenditure. The preliminary results warrant further investigation in a multicenter trial.

Adult↗
PubMed1996

Sleep apnoea in treated acromegaly: relative frequency and predisposing factors.

OBJECTIVES: Sleep apnoea is common in active acromegaly. It is associated with increased morbidity and mortality but can be treated effectively. The objective of this study was to determine the largely unknown relative frequency of, and the predictive factors for, sleep apnoea in treated acromegalic patients. DESIGN: Retrospective cohort study. SETTING: Tertiary referral hospital. PATIENTS: Fifty-four of 100 patients with treated acromegaly. If sleep apnoea had been diagnosed before acromegaly, the patient was excluded. MEASUREMENTS: Sleep studies (using the MESAM-4 device measuring oxyhaemoglobin saturation, heart rate, snoring sounds and body position to determine presence and severity of sleep apnoea); GH and IGF-I levels; body mass index, neck and index-finger circumference; daytime symptoms of sleep apnoea, duration of acromegaly before treatment, shoe and neck-size difference since beginning of acromegaly; age, sex and treatment modes of acromegaly. RESULTS: The relative frequency of sleep apnoea was 39% in the 54 patients with sleep studies and at least 21% in the entire study population of 100 patients. In patients with sleep apnoea, statistically significant higher values were observed for GH (P = 0.002), IGF-I (P = 0.029), age (P = 0.014) and neck circumference (P = 0.016). An index-finger circumference of > or = 8.5 cm was associated with a significantly higher desaturation index (P = 0.012, Mann-Whitney U-test). Adenomectomy had been performed significantly less frequently in patients with sleep apnoea (P < 0.001, X2 test). The body mass index was non-significantly higher in the patients with sleep apnoea. CONCLUSIONS: The relative frequency of sleep apnoea in patients with treated acromegaly is at least 21%. Parameters of predictive value for the presence of sleep apnoea in this population are neck and index-finger circumference as measures of soft tissue hypertrophy, age, GH and IGF-I levels, and whether or not operative therapy was applied.

Acromegaly↗
PubMed1996

[Damage to the lumbosacral plexus in psoas hitch operation].

The psoas hitch operation is used for the management of ureteral disease requiring replacement of varying lengths of the ureter. During this procedure the bladder is fixed to the psoas by 2 or 3 hitches of nonresorbable suture. Astonishingly, peripheral nerve injury to the lumbosacral plexus has not yet been described as a complication even though it has been seen when the psoas muscle was hitched unintentionally during abdominal surgery. Within 14 days we saw 2 patients with damage to parts of the lumbosacral plexus following a psoas hitch. In one case, hypesthesia and exercise-related pain in the areas supplied by the genitofemoral, the ilioinguinal and femoral nerve persisted, suggesting inclusion of at least parts of those nerves in the hitch. Initial paresis of hip flexion did not persist and the second patient recovered without sequelae. According to the literature this kind of complication does not occur if visible nerves are avoided and stitches an used that are no deeper than 3 mm into the psoas muscle.

Adult↗
PubMed1995

Neurological sequelae of cyanide intoxication--the patterns of clinical, magnetic resonance imaging, and positron emission tomography findings.

We report 2 patients with neurological sequelae of oral cyanide intoxication who were evaluated clinically and neuropsychologically, with high-resolution magnetic resonance imaging and one of them with positron emission tomography. The clinical syndrome was characterized by extrapyramidal motor and cerebellar symptoms such as bradykinesia, hypomimia, slowed speech, anteropulsion, and marked retropulsion, but little tremor. The sensory and pyramidal motor systems were normal or relatively spared. On neuropsychological testing the intellectual capacity and memory functions were normal, whereas the speed of motor reaction and verbal fluency were reduced. Magnetic resonance imaging showed damage of the globus pallidus, putamen, substantia nigra, subthalamic nucleus, and cerebellum in both patients, whereas the sensory-motor cortex and hippocampus were relatively spared. 18F-6-Fluoro-dopa positron emission tomography revealed a symmetrical reduction of striatal dopa uptake by 42% on average that was similar in the putamen and caudate. 18F-2-Fluoro-2-deoxyglucose positron emission tomography showed a regional reduction of the glucose metabolism in the posterior putamen and temporo-parieto-occipital and cerebellar cortex.

Adult↗
PubMed1995

Pilot study of a new treatment concept for acute Guillain-Barré syndrome.

The pathogenesis of acute Guillain-Barré syndrome (GBS) is unknown as yet. Numerous clinical and experimental data suggest an autoimmune disorder. Controlled multicenter trials have demonstrated the efficacy of plasma exchange and intravenous immunoglobulin (IgG). A combination of these treatments appears to be a promising concept. We assume that initial selective adsorption treatment eliminates the postulated circulating pathogenetic agent and thereby allows for a more effective immunomodulation by the subsequent administration of i.v. IgG. In a pilot study of 30 patients (11 plasma exchange, 7 selective adsorption, and 12 patients treated with selective adsorption and subsequent administration of i.v. IgG) we found no significant differences for the variables including disability on admission, maximal disability, change of disability during treatment, and disability on discharge. Moreover, we found no apparent differences with respect to tolerance of the procedures or procedural side-effects. We conclude from these preliminary findings that these treatment regimens are viable and safe procedures and result in similar clinical improvement. Statistical evaluation of the efficacy of this treatment concept can only be done after a multicenter study of a large patient group.

Acute Disease↗
PubMed1993

Adsorption therapy with tryptophan-conjugated polyvinyl alcohol gels in 10 patients with acute Guillain-Barré syndrome.

In 10 cases of acute Guillain-Barré syndrome selection adsorption (SEA) of immunoglobulins was performed with IM TR350 columns (Asahi Medical, Japan). During this therapy the symptoms of 8 patients were reduced. Side effects were moderate and not specific for SEA. The columns removed large amounts of immunoglobulins, but also eliminated other plasma components.

Acute Disease↗