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Biomedical subjects

H Gastaut

Publications and source records attributed to H Gastaut.

At least 37 records · Page 2Linked to original sources
PubMed1984

[Absence status with unilateral EEG predominance (apropos of a personal case report)].

The authors describe a 33-year-old woman who, from the age of 15 years, presented many generalized epileptic seizures per year starting with right-sided adversion or gyration, several times per month long absences and occasional absence status lasting up to 3 days. In this patient, the hyperpnoea provoked a clinically typical absence status with 3 c/sec rhythmic continuous spike-and-wave discharges which were more evident on the left frontal regions of the scalp. This electro-clinical picture is compared to similar cases described in the literature and its nosological specificity is discussed.

Adult↗
PubMed1984

New comments on the epilepsy of Fyodor Dostoevsky.

Based on recent data on the symptomatology of epileptic seizures and the interictal behavior shown by Dostoevsky, the author considers the debate open as to whether Dostoevsky presented primary generalized epilepsy or temporal lobe epilepsy. It is concluded that the most reasonable hypothesis on this subject is an eclectic one, wherein both etiologies of epilepsy would have been present with Dostoevsky displaying both of the following: a lesion of the temporal lobe of very discreet magnitude, thus lacking mental or somatic expression in the interictal period; and a constitutional predisposition to epilepsy of sufficient magnitude to render epileptogenic this otherwise silent temporal lesion, thus leading to a practically immediate secondary generalization of each seizure.

Art↗
PubMed1984

Gustave Flaubert's illness: a case report in evidence against the erroneous notion of psychogenic epilepsy.

The concept of psychogenic epilepsy was recently revived by Sartre (L'Idiot de la Famille, 1971-2) in relation to Gustave Flaubert's epilepsy, which he believed was secondary to hysterical neurosis and not due to a cerebral lesion. A detailed clinical description of Gustave Flaubert's personal and medical history from birth to death is provided. The relationships between his epileptic seizures and both his personal life and the response of others to the attacks are discussed, as is the interaction between seizure occurrence and his literary work and productivity. The various diagnoses made by medical and nonmedical persons during and after Flaubert's lifetime are then reviewed. Particular emphasis is given to Sartre's purely psychogenic interpretation of the seizures, to his total disinterest in their medical aspects, and to the fact that he did not obtain any medical opinions. It is shown that a definitive diagnosis can be made for Flaubert's illness--that of epilepsy associated with a quite normal psychosocial response by current standards. Moreover, the clinical nature of the seizures and other clinical details permit the more specific diagnosis of "complex partial epilepsy of occipital-temporal origin, secondary to lesion of the left posterior hemisphere with occasional secondary generalization of seizures." The concept of the existence of "psychogenic epilepsy" is reaffirmed as erroneous, despite the occasional precipitation of seizures in some individuals by psychological factors. Finally, Gustave Flaubert's case, like Dostoevski's, points to the possible coexistence of a serious and poorly controlled form of epilepsy with true literary genius without the latter being dependent in any way on the former.

Epilepsy↗
PubMed1984

Startle-induced epileptic seizures.

The present study was undertaken in order to describe 16 more patients suffering from startle-induced epileptic seizures and to clarify further the possible therapeutic activity of benzodiazepines in this rare reflex epilepsy. The interictal and ictal electroclinical data of 16 epileptic children or adolescents have been detailed. A CT-scan was performed in 10 patients; six of them showed an atrophy of the mesial surface of one or both hemispheres ("mesial hypodensity"). Benzodiazepine was associated with the previous antiepileptic treatment in the 16 ineffectively treated patients. Clonazepam was administered in three patients; one of them was completely unresponsive and two became seizure-free for a mean of 16.5 months but complained of drowsiness or ataxia. Clobazam was administered in 13 patients; 15.4% of them were completely unresponsive, 23.1% experienced drug resistance, and 61.5% obtained a good control (91.5% reduction of the reflex seizures) for a mean of 22.75 months. In spite of a possible loss of therapeutic activity, the appearance of very few unfavorable side effects and the presence of favorable side effects ("psychomotor arousal") make clobazam therapy important in the treatment of patients suffering from startle epilepsy.

Adolescent↗
PubMed1984

Ictal visual hallucinations of numerals.

We studied three children with benign primary occipital epilepsy who had ictal numerical visual hallucinations. This unusual ictal event may occur in patients with left-sided, right-sided, or bilateral interictal spikes, and such attacks may begin in either occipital lobe. This event seems to be occipital, without limbic participation, although the ictal discharge may spread to limbic structures as the seizure evolves.

Child↗
PubMed1983

Long-term results of conventional surgical treatment for epilepsy. Delayed recurrence after a period of 10 years.

The results of the surgical treatment of epilepsy were studied in 44 patients 10 or more years after operation. Thirty-seven patients underwent operation only once; these patients were observed 11-26 years postoperatively. Seven patients had a recurrence within 5 years after operation and required a second operation; these patients were observed 11-17 years after the second operation. Recovery persisted for 15-27 years in 32 patients. There was a recurrence in 12 cases 11-19 years after operation. With one exception, these recurrences were satisfactorily treated medically.

Adolescent↗
PubMed1983

[Induced midday nap: a simple, effective method for sleep activation in epileptics].

The authors routinely carry out sleep activation in suspected cases of epilepsy when the EEG performed in the waking state gives insufficient data. The technique used, referred to as "the forced nap", allows to induce 60 min sleep in 80% of all subjects and 90% of those under 16 years of age. This method gives results comparable and probably better to those obtained by EEG recording subsequent to total deprivation of sleep for 24 hours but is much simpler to carry out and can be used by all hospital based EEG laboratories. The widespread use of this method should allow to change the current situation wherein more than 50% of hospital EEG laboratories do not perform sleep activation and the remaining centers restrict this technique to a very limited number of patients, thus depriving almost all epileptics of an effective diagnostic tool.

Adolescent↗
PubMed1982

Stuporous states or coma induced by the rapid administration of high doses of sodium valproate.

7 cases of stuporous states or coma induced in epileptic subjects by the rapid administration of high doses of sodium valproate are described. Progressive impairment of consciousness began 2 to 7 days after the administration of sodium valproate and induced a slowing of background EEG activity until the delta activity became of high amplitude, generalized, continuous and areactive. The authors believe that the impairment of consciousness in their patients was related to the rapid administration of high doses and a direct intrinsic action of sodium valproate on the brain, as no increase in plasma levels of the drugs in association with valproate was observed.

Adult↗
PubMed1982

[Benign spike-wave occipital epilepsy in children].

Among the partial epilepsies of childhood with a mainly if not exclusively functional focus, a place must be given, next to epilepsy with rolandic spikes, to 'benign epilepsy with occipital spike-waves' featuring: (1) from the EEG standpoint: (a) normal background activity; (b) interictal high amplitude S.W. occurring only when the eyes are closed and recurring more or less rhythmically in the occipito-posterotemporal region of one or both hemispheres (in the last case synchronously or asynchronously, symmetrically or asymmetrically); (c) ictal localized self-maintaining discharges over one occipital lobe, even when the interictal S.W. are bilateral; (2) from the clinical standpoint: (a) between seizures: normal neuropsychiatric, neuroradiological, CT and ophthalmological status; (b) during seizures: visual symptoms (amaurosis, phosphenes, complex hallucinations or illusions) which are: (i) isolated when the ictal neuronal discharge remains confined to the occipital region; (ii) followed by hemiclonic or automatic or cephalalgic manifestations when the occipital discharge extends to the central or temporal regions or to the brain stem. The observed symptomatology, associated with a family history of epilepsy in 36% of cases, confirms that this syndrome is indeed true epilepsy and not basilar migraine with severe epileptiform abnormalities as supposed by Camfield et al. (1978). Benign epilepsy of childhood with occipital S.W. is essentially functional in nature, depending on epileptic predisposition acting to uncover a minimal brain lesion probably acquired at birth. The prognosis is good, although less satisfactory than that of benign epilepsy with rolandic spikes.

Adolescent↗
PubMed1982

[Gustave Flaubert's illness].

All those interested in Gustave Flaubert's illness, during his lifetime as well as after his death, have agreed that he had epilepsy. The one important exception is Jean-Paul Sartre, who, in the 2800 pages of his "Idiot de la famille" claimed that Flaubert was a hysteric with very moderate intelligence who somatized his neurosis in the form of seizures. These, in Sartre's views, were moreover probably hysterical, but possibly epileptic resulting from the existence of a psychogenic epilepsy bred from the neurosis. The basis for this neurosis could have originated at the time of Gustave's birth, as this occurred between those of two brothers who both died young, and as his mother had wished for a daughter. Further development of the neurosis might have taken place during a temporary phase of learning difficulties, exaggerated and exploited by his father to make his youngest son the idiot of a family in which the eldest son was the dauphin. Destroyed in this way, Gustave would have sought refuge in passivity and could have developed a hatred for his father and for his elder brother, who he would have liked to kill before killing himself. But, unable to carry out his wishes and desiring both to die and to survive, Gustave, adolescent, might have chosen the pathway of "false deaths", as exemplified by the seizures. Modern epileptology data enables not only to confirm the epileptic etiology and to discount the hysterical nature of the fits, but also: 1. to establish precise details of the site and nature of the cerebral lesions responsible for the attacks: neonatal atrophy or vascular malformation of the occipitotemporal cortex of the left hemisphere, the only lesion capable of provoking: a) the phosphenes marking the onset of the seizures; b) the intellectual manifestations (forced thoughts or flight of ideas), affective features (panic terror), and psychosensory (ecmnesic hallucinations) or psychomotor (confusional automatism) symptoms accompanying some attacks; c) the loss of speech preceding the loss of consciousness and terminal generalized convulsions. 2. to establish the consequences of the lesion and of the temporal fits on the behaviour of the writer; a) associated hypoactivity (slowness of ideation and writing) and paroxysmal impulsiveness (violent unmotivated angry outbursts); b) disturbed verbal functions (difficulty in finding words); and c) diminished sexuality. As a conclusion, it must be admitted; a) that Flaubert suffered from an organic and not a psychogenic epilepsy, the existence of the latter currently being disputed; b) that this epilepsy modified the behaviour of the author without affecting his genius; c) that, as a result of this, the epilepsy of Flaubert, as that of Dostoïevski, should serve as a defense witness for the unfortunate epileptics thought to be destined for intellectual deterioration only because of the repetition of their seizures.

Conversion Disorder↗