[Monitoring and control of anesthesia in epilepsy from the viewpoint of the neurologist].
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Anesthesia, General↗
Biomedical subjects
H Stefan
Publications and source records attributed to H Stefan.
Plasma GABA and seizure control with vigabatrin.
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Adolescent↗
Clinical applications of MEG in epilepsy.
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Epilepsy↗
Brain-stem lesions in the course of a presurgical re-evaluation by foramen-ovale electrodes in temporal lobe epilepsy.
Two of 4 patients who were re-evaluated by means of foramen-ovale electrodes in the course of presurgical monitoring suffered a brain-stem lesion. Only 1 of these 2 patients already had a temporal resection. None of 55 patients who underwent this procedure for the first time had such a complication. We conclude that this electrode technique is not indicated to evaluate patients a second time, even if no surgical resection has been performed between the 2 recording sessions.
Brain Diseases↗
Determination of GABA and vigabatrin in human plasma by a rapid and simple HPLC method: correlation between clinical response to vigabatrin and increase in plasma GABA.
The novel antiepileptic drug vigabatrin (Sabril) acts by inhibiting degradation of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), increasing the GABA concentrations in the brain. Because the GABA degrading enzyme GABA aminotransferase (GABA-T) is also present in peripheral tissues, including blood platelets, measurement of plasma GABA levels might be a useful indication of the pharmacological response to vigabatrin during therapeutic monitoring. However, because of the very low concentrations of GABA in plasma, the few methods available for plasma GABA analysis are time-consuming, difficult to perform and/or not selective enough because of potential interference with other plasma constituents. In the present study, a rapid, selective and sensitive amino acid analysis HPLC method has been developed for plasma GABA determination with fluorescence detection, using o-phthaldialdehyde as a precolumn derivatizing agent. By employing a 3 microns particle size reversed-phase column and a multi-step gradient system of two solvents, the very low endogenous concentration of GABA in human plasma could be reproducibly quantitated without interference of other endogenous compounds. Incubation of human plasma samples with GABA degrading enzyme(s) resulted in an almost total loss of the GABA peak, thus demonstrating the specificity of the method for GABA analysis. In addition to GABA and other endogenous amino acids, the HPLC method could be used to quantitate plasma levels of vigabatrin. Thus, this improved HPLC amino acid assay might be used to examine whether concomitant monitoring of plasma GABA and vigabatrin is useful for clinical purposes. This was examined in 20 epileptic patients undergoing chronic treatment with vigabatrin. The average plasma GABA level of these 20 patients did not differ significantly from non-epileptic controls. However, when epileptic patients were subdivided according to their clinical response to vigabatrin, vigabatrin responders had significantly higher GABA levels than nonresponders or controls. In contrast to the difference in plasma GABA, vigabatrin responders and nonresponders did not differ in dose or plasma level of vigabatrin. These data may indicate that determination of plasma GABA is a valuable non-invasive method for therapeutic monitoring in patients on medication with vigabatrin.
Adult↗
Multichannel magneto-electroencephalography recordings of interictal and ictal activity.
A lobar or even a intralobar congruence was found when comparing the findings of magnetic source localization with presurgical evaluation (EEG, MRI and intraoperative ECoG) in temporal lobe epilepsy. The first dipolar activity that can be recognized during a spike-wave event (primary focal epileptic activity (PFA)) was localized in temporal neocortical or mesial regions. Further centres of epileptic activity could be localized by the method of spike averaging by correlation. This was interpreted as propagation of the electric activity. The comparison of interictal and ictal MEG localization results showed congruency in a patient with temporal lobe epilepsy. The combination of MEG and MRI helps to build a bridge between morphological and functional localization. MEG can serve as a pointer to discrete lesions in MRI.
Electroencephalography↗
Hyperventilation and transcranial magnetic stimulation: two methods of activation of epileptiform EEG activity in comparison.
In a prospective study, we compared the established method for an activation of epileptiform activity in EEG, hyperventilation (HV), with the recently presented new activational technique of transcranial magnetic stimulation (TMS) in 10 patients with drug-resistant partial epilepsies. Long-term EEG recordings included subdural electrodes in the course of presurgical evaluation. Epileptiform activity was evaluated visually 500 s before, during, and 500 s after stimulation, and the results were compared statistically. TMS was not better than HV: HV caused an activation of the epileptogenic foci in 6 of 10 cases, TMS only in 3 of 10. Seizures could be induced by HV in 2 of 10, by TMS in no cases. In 2 of 10 cases, TMS even caused a significant reduction of epileptiform activity.
Adolescent↗
[Functional and structural follow-up findings in complicated migraine].
The rare case of a status of complicated migraine with more than two weeks duration and severe neurological deficits is reported. The clinical symptoms were global aphasia, mild fluctuating hemiparesis on the right side and headache without localization on one side. The presence of a characteristic constellation of morphological and functional findings on investigation (EEG, SPECT, TCD) helped to clarify the diagnosis. In addition, the functional investigations proved remarkably valuable in following the course of the illness. The decrease of clinical symptoms was clearly correlated with SPECT and TCD findings, while CCT and MRT remained unspecific and EEG did not become normal.
Adult↗
[Congenital epispadias with urinary incontinence: long-term results of reconstructive therapy].
The author investigated the long-term results after reconstruction operations in epispadias with total urinary incontinence in 16 pediatric patients-4 girls and 12 boys. The patients were operated in 1961-1981 at the Department of pediatric surgery of the University Hospital in Hradec Králové. The operations were made most frequently between the age of 3 and 4 years. Straightening of the penis was achieved by exstirpation of the dorsal chorda and by V-Y plasty. To lengthen the penis it proved useful to separate the greater portion of the crura from the bony rami. To achieve functional continence plastic operations were made of the posterior urethra and of the bladder neck in patients of both sexes. The Young-Dees procedure proved best. The overall continence rate was achieved in 70% of operated boys and in 60% of girls. The functional failure of reconstruction was treated by secondary diversion in 2 cases, in one by ureterosigmoideostomy and in one by ileal conduit. The associated VUR reflux was corrected by Politano-Leadbetter's UCN or by the Cohen procedure. From the social aspect the patients are well adapted, they completed their training for a job. Of 12 patients where an inquiry for further information was made, with the exception of one patient, all are active in their sexual life. Seven patients are married, five men fathered 7 children and two female patients were delivered of three healthy children.
Child↗
[Functional reconstruction of urinary bladder exstrophy: long-term follow-up of urinary continence].
The author followed up a group of seven patients 5 to 29 years after functional reconstruction without augmentation on account of classical exstrophy of the urinary bladder. The plastic operation to ensure continence was performed in 5 boys and 2 girls at the age of two and a half to 23 months, in six cases by the Young-Dees' method and in one patient by Leadbetter's method. Posterior iliac osteotomy was performed in two and an antireflux plastic operation was performed in four patients. In one patient a disruption of the plastic operation of the abdominal wall occurred on the fourth day after reconstruction. Continence was excellent in five patients and satisfactory in two. Among the many factors for urinary continence a plastic operation of the posterior urethra and neck of the bladder is most important as it creates the appropriate length of the continence zone and the adequate pressure on closure. In the discussion the author emphasizes the advantage to start with the reconstruction of the abdominal wall and bladder during the neonatal period and to proceed in stages. The functional closure of the bladder and its neck with the posterior urethra should be implemented after a minimal capacity of 60 ml has been attained. Augmentation enterocystoplasty is indicated on account of urinary incontinence as a secondary operation if the function of the urethra and neck of the bladder is satisfactory and achieved capacity is less than 100 ml.(ABSTRACT TRUNCATED AT 250 WORDS)
Bladder Exstrophy↗
[Unclear cerebral fits].
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Carbamazepine↗
The effect of a synthetic GnRH analogue on catamenial epilepsy: a study in ten patients.
Ten female patients suffering from catamenial epilepsy were treated with a synthetic analogue of the gonadotrophin releasing hormone (GnRH) in addition to antiepileptic drugs. Three of the patients became seizure free, in four patients seizure frequency decreased and in one patient seizures were of shorter duration. In only two of the patients was there no therapeutic effect. Adverse effects, including hot flushes, headache and increase in weight, were noticed in eight patients. These results support the hypothesis that treatment with a synthetic GnRH analogue might be helpful in patients with intractable catamenial epilepsies.
Adult↗
Isoflurane anaesthesia in the treatment of convulsive status epilepticus. Case report.
Status epilepticus may be resistant to intravenous anticonvulsive drugs. In these cases treatment with the inhalation anaesthetic agent isoflurane may be helpful in the further management. We describe a 35-year-old female patient who suffered from status epilepticus with partial seizures. In spite of therapy with benzodiazepine and phenytoin the status evolved into tonic clonic seizures. Treatment with thiopentone sodium did not stop seizure activity. Anaesthesia with isoflurane (dosage up to 1.5 vol.%) carried out twice within 72 h finally led to a termination of status epilepticus. From our own experience and reports in the literature we conclude that general anaesthesia with isoflurane can and should be used in the treatment of severe status epilepticus that does not respond to intravenous anticonvulsive agents.
Adult↗
Exhaustion of postictal serum prolactin release during status epilepticus.
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Adult↗
Serum prolactin concentrations and epilepsy. A study which compares healthy subjects with a group of patients in presurgical evaluation and circadian variations with those related to seizures.
In 20 healthy subjects (10 female and 10 male) and 17 patients undergoing presurgical epilepsy evaluation with intracranial EEG electrodes, circadian variations of serum prolactin (PRL) were measured. A comparison between the peak values found in normals with the postictal rises in patients, led us to consider 700 microU/ml to be the threshold of diagnostic value and the observed rises above this level to be all induced by seizures. In order to assess the clinical value of this threshold, PRL was measured postictally in a further 30 patients with epilepsy and in 11 patients with psychogenic seizures. In none of the latter group did PRL rises exceed 700 microU/ml, while they did so in 39% of the complex partial seizures and in 80% of the tonic-clonic seizures. There was no significant difference with respect to sex (a rise over 700 microU/ml in 42% in male and in 55% in female patients). Based on the findings in 17 patients investigated by means of intracranial electrodes, we were not able to establish different criteria for different focus localisations: in 66% of both temporal as well as frontal lobe seizures the 700 microU/ml level was exceeded. As a trend, in the period preceding an epileptic seizure we found a slightly decreasing PRL level, whereas in healthy persons the PRL concentrations gradually increased in the 40 minutes before the maximum spontaneous peak was reached.
Adolescent↗
[Clinical symptoms and therapy of status epilepticus].
The term "status epilepticus" was first coined in 1824 by Calmeil as this condition had such a poor prognosis. Although still commonly misused today, from the beginning this term actually included all kinds of epileptic seizures, since there are as many types of status epileptici as there are seizure types. Status epileptici are usually triggered by a combination of factors including sleep deprivation, alcohol withdrawal, failure to take medication regularly and fever. In status epilepticus epileptic seizures and EEG discharges initially appear to be no different from isolated seizures. The longer the status epilepticus continues, however, the more atypical the seizures and EEG discharges become. Usually status epilepticus ends gradually. Irreversible damage or fatalities may occur especially in infants or under certain conditions (e.g. long status duration, protracted interval between seizure onset and medical treatment and symptomatic etiology). In most cases benzodiazepines and diphenylhydantoine are the preferred drugs used for treatment.
Anti-Anxiety Agents↗
Reconstruction of the penis following necrosis from circumcision used high frequency cutting current.
Penis necrosis secondary to circumcision by an electrical scalpel in a 2 years and 2 months-old boy occurred. After healing of the electric burn only stumps of the erectile bodies and strictured urethral meatus remained. The penis shaft reconstruction by corpora mobilisation and by detachment of the crura from the pubo-ischial rami was effected. This procedure gained 6 cm of a new length of the penis. To prevent readhesions to the puboischial rami the penis was buried in a scrotal tunnel. Six months later the denuded shaft was resurfaced with one split thickness skin graft and a zigzag seam on the ventral side was made. The patient voids with good stream, has spontaneous erections and nocturnal emissions. During 10-years follow-up after the reconstruction two complications, namely a stricture of the urethra and a slight dorsal tethering of the penis caused by a scarred pubic skin were treated. The problems of the a reconstruction type and resurfacing of the penis in childhood are discussed.
Child, Preschool↗
Reconstruction of the penis following necrosis from circumcision used high frequency cutting current.
Penis necrosis secondary to circumcision by an electrical scalpel in a 2 years and 2 months-old boy occurred. After healing of the electric burn only stumps of the erectile bodies and strictured urethral meatus remained. The penis shaft reconstruction by corpora mobilisation and by detachment of the crura from the pubo-ischial rami was effected. This procedure gained 6 cm of a new length of the penis. To prevent readhesions to the puboischial rami the penis was buried in a scrotal tunnel. Six months later the denuded shaft was resurfaced with one split thickness skin graft and a zigzag seam on the ventral side was made. The patient voids with good stream, has spontaneous erections and nocturnal emissions. During 10-years follow-up after the reconstruction two complications, namely a stricture of the urethra and a slight dorsal tethering of the penis caused by a scarred pubic skin were treated. The problems of the a reconstruction type and resurfacing of the penis in childhood are discussed.
Circumcision, Male↗