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Biomedical subjects

G Erenberg

Publications and source records attributed to G Erenberg.

At least 37 records · Page 2Linked to original sources

The natural history of Tourette syndrome: a follow-up study.

Initial reports described Tourette syndrome as a lifelong disorder. Since then, others have noted that some patients experience remissions during late adolescence. To examine this issue, we sent questionnaires to 99 patients with Tourette syndrome who were 15 to 25 years old. The majority of the 58 respondents indicated that they had fewer tics as they reached late adolescence or young adulthood. Although most reported associated behavior or learning problems, the majority felt they were coping well. The long-term outcome in many patients with Tourette syndrome may be more optimistic than previously reported.

Adaptation, Psychological↗

Clinical outcome after complete or partial cortical resection for intractable epilepsy.

This is the first epilepsy surgery series to analyze the definition of "completeness" of resection, based solely on results of chronic scalp and subdural EEG recording. When patients had complete removal of all cortical areas with ictal and interictal epileptiform discharges, the clinical outcome was usually good. When areas with epileptiform discharges were left behind, good outcome was significantly less frequent. This correlation between complete resection and good outcome was independent of the presence or absence of CT-detected structural lesions or sharp waves on post-resection electrocorticography. These results support completeness of resection, defined by prolonged extraoperative EEG, as an important factor in seizure surgery.

Adolescent↗

Fusiform basilar artery aneurysm in a 33-month-old child.

A 33-month-old girl presented with acute subarachnoid hemorrhage from a ruptured multilobulated fusiform aneurysm of the midbasilar artery. This rare lesion was treated surgically by occluding the basilar artery. Intraoperative brain stem auditory evoked potential and somatosensory evoked potential monitoring results did not change with basilar artery occlusion, suggesting that the occlusion would be tolerated. However, the amplitudes of brain stem auditory evoked potential Waves III-V to right ear stimulation were transiently reduced during left pontine retraction during the aneurysm exposure. The patient made a complete clinical recovery.

Aneurysm↗

Gilles de la Tourette's syndrome: effects of stimulant drugs.

We reviewed the medication histories in 200 children with Gilles de la Tourette's syndrome to investigate how frequently CNS stimulants may unmask a latent syndrome or worsen existing tics. Forty-eight patients had received stimulant drugs. Nine were treated before the onset of tics, but only four were still receiving stimulants when tics began. In 39 patients with preexisting tics, stimulants increased tics in 11, caused no change in 26, and decreased tics in 2. Behavior improved in 22 patients. Thirteen of these 22 had no increase in tics when stimulants were used. Cautious trials of stimulant therapy may benefit some patients with this syndrome.

Central Nervous System Stimulants↗

Pancreatitis associated with valproic acid therapy.

Four patients had pancreatitis associated with valproic acid therapy. Three patients received valproic acid at usual doses, and all were free of other symptoms of toxic reactions, with serum levels of valproic acid in the usual therapeutic range. Two patients underwent exploratory laparotomy prior to diagnosis. Complications included pseudocyst, pericardial effusion, laparotomy wound infection, and coagulopathy. All patients recovered with discontinuation of valproic acid therapy and enteral feeding and administration of intravenous fluids. After recovery, a valproic acid regimen was restarted uneventfully (in one patient). All were asymptomatic with normal serum amylase levels after five to 14 months. Pancreatitis is a serious complication of valproic acid therapy that must be considered in any patient receiving valproic acid who experiences severe abdominal pain and vomiting.

Abdomen↗

Hypothermia and barbiturate coma for refractory status epilepticus.

Three pediatric patients with generalized status epilepticus unresponsive to therapy with conventional anticonvulsants were successfully treated with moderate hypothermia (30 degrees to 31 degrees C) and barbiturate coma with thiopental. All 3 patients were treated with thiopental at doses producing burst suppression or an isoelectric tracing on the EEG and thiopental and barbiturate levels were followed sequentially in the plasma. Continuous thiopental infusion rates of 5 to 55 mg/kg X h maintained burst suppression and correlated with plasma thiopental levels of 25 to 40 mg/dl. Total doses of thiopental used to obtain and maintain burst suppression ranged from 15 to 50 g over 48 to 120 h. In all 3 patients, control of the status epilepticus was obtained. Moderate hypothermia and thiopental barbiturate coma are indicated in patients with generalized tonic-clonic status epilepticus which cannot be controlled with standard anticonvulsant drug therapy. This regimen has the advantage that the patient can be managed in an ICU without the need for general anesthesia with volatile anesthetic agents.

Adolescent↗

Valproic acid in the treatment of intractable absence seizures in children: a single-blind clinical and quantitative EEG study.

A 12-week single-blind study used valproic acid in the treatment of refractory, simple and complex absence (petit mal) seizures in 17 children. The clinical seizure control was compared with the number and duration of electrical discharges on six-hour EEG recordings before and during therapy. Sixteen patients showed clinical improvement. Fourteen had greater than 75% clinical improvement and ten patients became free of absence seizures. Side effects were mild, but two patients experienced transient, asymptomatic thrombocytopenia. Good correlation between clinical response and decreasing seizure activity on the EEG occurred in the seizure-free patients.

Adolescent↗

Benign focal epileptiform discharges in childhood migraine (BFEDC).

Interictal EEGs were studied in 100 children, ages 3 to 15 years. Records were interpreted independent of history; 89% were normal, 9% had benign focal epileptiform discharges (BFEDC), one had temporal spikes, and one had background slowing. The nine patients with BFEDC did not differ from the others. None had epilepsy. This incidence of 9% is higher (p less than 0.0001) than the incidence of BFEDC in the normal population (1.9%). The significance of this finding is not clear, but migraine and benign focal epilepsy of childhood may be genetically linked, or the vascular abnormality of migraine may cause brain injury to produce sharp waves of low epileptogenicity. These results do not suggest that headaches are epileptic.

Adolescent↗