Response to B.s. Kasper, acta neuropathol (2002) 103:307.
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Brain↗
Biomedical subjects
K Malmgren
Publications and source records attributed to K Malmgren.
Nonorganic and Organic Psychiatric Disorders in Patients after Epilepsy Surgery.
This study aimed at describing preoperative psychiatric morbidity in a consecutive series of 70 epilepsy patients who were surgically treated and to analyze postoperative psychiatric morbidity and predisposing factors. Nonorganic (DSM-III-R) and organic (Lindqvist-Malmgren diagnostic system) psychiatric morbidity was prospectively assessed preoperatively and during the first two postoperative years. At presurgical evaluation 44.3% of the patients had a psychiatric diagnosis (nonorganic in 14.3%, organic in 38.6%). The most common nonorganic diagnosis was major depression; the most common organic diagnosis was Astheno-Emotional disorder (AE disorder). During the first two postoperative years 68.1% of the patients received some psychiatric diagnosis. The most common nonorganic diagnoses were anxiety and depressive disorders (AD disorders) in 36.2%; the most common organic diagnosis was AE disorder in 52.2%. Patients with a preoperative history of AD disorders or AE disorder had a significantly higher risk of postoperative AD disorders (P < 0.01 and P < 0.001 respectively). Laterality, type of resection, histopathological diagnosis, or outcome were not significantly related to postoperative psychiatric morbidity. The importance of psychiatric assessment, including organic psychiatric disorders, is emphasized.
Journal Article↗
Widespread microdysgenesis in therapy-resistant epilepsy--a case report on post-mortem findings.
Microdysgenesis is a subtle malformation, which is often found in specimens from epilepsy surgery. It is, however, not clear whether the changes are focal or diffuse. A recent autopsy case offered an opportunity to investigate whether microdysgenesis found after temporal lobe surgery was focal or widespread in the brain. The entire brain of a 20-year-old patient who died suddenly and unexpectedly was examined histologically. Microdysgenesis had previously been diagnosed after a left temporal lobectomy performed because of therapy-resistant seizures. A light microscopic examination was performed on specimens stained with Luxol-fast blue-cresyl violet and polyclonal antibodies to glial fibrillary acidic protein. Widespread microdysgenesis with irregular nerve cell distribution in the cortex and an increased number of nerve cells in cortical layer I and in the white matter was found in the right temporal and parietal lobes and bilaterally in the frontal and occipital lobes. The post-mortem examination confirmed the previous diagnosis of microdysgenesis and showed that the changes were widespread in a patient who was operated on because of focal epilepsy.
Adult↗
Guidelines for the use of EEG methodology in the diagnosis of epilepsy. International League Against Epilepsy: commission report. Commission on European Affairs: Subcommission on European Guidelines.
The Commission of European Affairs of the International League Against Epilepsy published 'Appropriate Standards for Epilepsy Care Across Europe' which contained recommendations for the use of electroencephalography (EEG) in the diagnosis of epilepsy (Brodie et al. Epilepsia 1997; 38:1245). The need for a more specific basic document of EEG methodology was recognized and the Subcommission on European Affairs was asked to produce more detailed guidelines to be used across Europe recognizing the range of practices in EEG laboratories. There are many general guidelines published on EEG methodology but this document focuses on the diagnosis of epilepsy. Details from previously published guidelines are included in references and in an appendix. These guidelines are not meant to be used as minimal standards but recommendations that can be applied to all EEG laboratories despite variations in equipment.
Adult↗
Lateralisation with magnetic resonance spectroscopic imaging in temporal lobe epilepsy: an evaluation of visual and region-of-interest analysis of metabolite concentration images.
We carried out spectroscopic imaging (MRSI) on nine consecutive patients with temporal lobe epilepsy being assessed for epilepsy surgery, and nine neurologically healthy, age-matched volunteers. A volume of interest (VOI) was angled along the temporal horns on axial and sagittal images, and symmetrically over the temporal lobes on coronal images. Images showing the concentrations of N-acetylaspartate (NAA) and of choline-containing compounds plus creatine and phosphocreatine (Cho + Cr) were used for lateralisation. We compared assessment by visual inspection and by signal analysis from regions of interest (ROI) in different positions, where side-to-side differences in NAA/(Cho + Cr) ratio were used for lateralisation. The NAA/ (Cho + Cr) ratio from the different ROI was also compared with that in the brain stem to assess if the latter could be used as an internal reference, e. g., for identification of bilateral changes. The metabolite concentration images were found useful for lateralisation of temporal lobe abnormalities related to epilepsy. Visual analysis can, with high accuracy, be used routinely. ROI analysis is useful for quantifying changes, giving more quantitative information about spatial distribution and the degree of signal loss. There was a large variation in NAA/ (Cho + Cr) values in both patients and volunteers. The brain stem may be used as a reference for identification of bilateral changes.
Adolescent↗
Pre--and postoperative general neurocognitive status and memory in 70 epilepsy surgery patients.
PURPOSE: To describe cognitive function preoperatively and cognitive change 2 years postoperatively in 70 consecutive adults in the Göteborg epilepsy surgery series. METHODS: Analysis of general neurocognitive status and memory for the total group and for three subgroups: 26 patients with seizure onset in dominant temporal lobe, 28 patients with onset in non-dominant temporal lobe and 12 with frontal lobe onset. Preoperative performance was compared with a control group (n=30). RESULTS: Preoperatively, patients were more impaired in general neurocognitive status than controls. Patients in the temporal lobe subgroups performed worse than controls in two memory variables. No postoperative negative change was found at group level. There was a small increase in Full Scale IQ and Performance IQ for the total patient group, and in Performance IQ for the frontal lobe subgroup. At individual level, many patients suffered losses or obtained gains in a number of memory variables without any consistent intra-pattern. CONCLUSIONS: Cognitive stability was the main postoperative result. The importance of considering inter- and intra-individual variability of negative as well as positive change is emphasized.
Adult↗
Vigabatrin visual toxicity: evolution and dose dependence.
PURPOSE: To investigate the prevalence and prognosis of visual field defects (VFDs) in epilepsy patients with and without vigabatrin (VGB) treatment; to investigate the possible relationship between VFDs and cumulative VGB dose, and to characterise the evolution of VFDs. METHODS: A cohort of 155 presurgical candidates who had undergone full-field Goldmann perimetry (GP) was studied, 99 (64%) of whom had been treated with VGB. All GPs were reevaluated in 1998 by one experienced examiner, blinded to medication. Duration of treatment and total VGB dose were related to perimetric results. RESULTS: Twenty-five (16%) of the 155 patients had VFDs: Nineteen (19%) of the 99 VGB-treated patients, and six (11%) of the 56 patients unexposed to VGB. VGB-treated patients with VFDs had been treated significantly longer than those without VFDs. Cumulative VGB dose could be calculated for 84 patients. The prevalence of VFDs increased significantly with increasing total VGB-dose, from 4% in the 51 patients who had been exposed to <or=1 kg VGB, to 75% in the eight patients with a total dose of 3-5 kg of VGB. Sixteen VGB-treated patients were reexamined 2-10 years later. In the 12 where evaluation was possible, all still had VFDs, which had worsened in five cases (42%) and improved in none. CONCLUSIONS: This study indicates a strong relationship between VFDs and duration and total dose of VGB. VFDs were irreversible and in a substantial percentage progressive. Similar VFDs may, however, also be found in patients unexposed to VGB. A model of the evolution of the VFDs in VGB toxicity is introduced, and a new simple visual field test is proposed.
Adult↗
Gabapentin versus vigabatrin as first add-on for patients with partial seizures that failed to respond to monotherapy: a randomized, double-blind, dose titration study. GREAT Study Investigators Group. Gabapentin in Refractory Epilepsy Add-on Treatment.
PURPOSE: Our objective was to compare the efficacy and safety of gabapentin and vigabatrin as first-line add-on treatment in patients with partial epilepsy. METHODS: This was a multicenter, double-blind, randomized dose titration study. After baseline assessment and randomization, the dose could be increased if seizures persisted and reduced if side effects occurred. Health-related quality of life was assessed at baseline and at the end of the study. By a protocol amendment post hoc, all randomized patients were offered a standardized perimetry examination at the end of the study. Improvement rate was the proportion of patients with a reduction of seizure frequency of at least 50% during an 8-week period without any adverse events causing withdrawal. RESULTS: One hundred two patients were randomized and analyzed on an intent-to-treat basis. The improvement rate was 48% in the gabapentin group and 56% in the vigabatrin group. The improvement rate, when per protocol criteria were fulfilled, was 57% in the gabapentin group and 59% in the vigabatrin group. The proportion of seizure-free patients was 31% in the gabapentin group and 39% in the vigabatrin group. There was no difference in quality-of-life scores between the groups. Perimetry after termination of the study on 64 patients showed abnormal results in 3 of 32 patients in the vigabatrin group. CONCLUSION: Approximately one third of the patients in both groups became seizure-free. Although no major differences were seen in terms of the improvement rate between the groups, equivalence between the two drugs was not found.
Acetates↗
[Goals of epilepsy treatment--a multidimensional model. The description of goals as a basis for efficiency measurement].
Review of relevant literature suggests at least seven distinct goals of epilepsy treatment to exist: to reduce seizure frequency and severity, to improve function, to enhance quality of life, to promote coping, to improve external circumstances, to prevent premature death, and (in children) to promote growth and development. However, these goals are subject to certain qualifications. For example, seizure frequency and severity is not to be reduced under all conditions, but only when such reduction can be expected to have beneficial effects on quality of life or on life expectancy (the two ultimate goals). The different qualifications suggest that the proposed goals can not, and should not be considered in isolation, but incorporated in a multidimensional model.
Adaptation, Psychological↗
Cross-cultural adaptation and use of the epilepsy psychosocial effects scale: comparison between the psychosocial effects of chronic epilepsy in Sweden and the United Kingdom.
PURPOSE: To establish Swedish weightings for the Epilepsy Psycho-Social Effects Scale (EPSES) and examine differences between Sweden and the U.K. in attitudes toward chronic epilepsy. METHODS: After translation and back-translation of the EPSES into Swedish, weightings were established through a paired comparison study in which 24 epilepsy professionals participated. The EPSES was then given to a hospital-based sample of 57 patients with chronic epilepsy and the results compared with a British sample matched for age, sex, and frequency of seizures. RESULTS: In the professional judgments of the EPSES statements, there were statistically significant differences in only four of 42 statements. Attitudes to employment, to medication, and to fear of seizures were considered more serious in the U.K., whereas social isolation was considered more a problem in Sweden. Patient attitudes to chronic epilepsy were found to be largely similar in the U.K. and Sweden; however, attitudes to employment, to the future, and to fear of seizures were significantly more a problem for patients in the U.K. CONCLUSIONS: The results indicate a great similarity in the interpretation of problems as measured by the EPSES in the U.K. and in Sweden. The differences in attitudes found are discussed in relation to economic and legislative differences between the two countries. Social as well as cultural differences should be taken into account when using standardized questionnaires. It is suggested that culturally specific weightings should be calculated and that these should be reevaluated at regular intervals.
Adult↗
Surgical treatment of epilepsy--clinical, radiological and histopathological findings in 139 children and adults.
The present study relates clinical and radiological data to histopathological diagnoses in the first 139 patients (children and adults) in the Göteborg Epilepsy Surgery series. Temporal lobe resections were most common (54.0%) followed by frontal lobe (18.0%) and multilobar resections (11.5%). All histopathological specimens were re-evaluated in connection with this study. Parenchymal malformations and atrophic-gliotic lesions were the most common histopathological findings. Microdysgenesis was more common than major malformations (24.5% versus 11.5%). When the MRI scans were blindly re-evaluated the MRI findings correlated with histopathological diagnosis in all of the vascular malformations, in 77.8% of the tumours, in 76.5% of the cases with hippocampal sclerosis but only in 28.6% of the major cortical development malformations. Hemispherectomies carried the best seizure outcome prognosis followed by temporal lobe resections (75.0% versus 57.3% seizure free 2 years after surgery). Vascular malformations carried the best, and microdysgenesis the worst prognosis (76.9% versus 39.4% seizure free).
Adolescent↗
Microdysgenesis in surgical specimens from patients with epilepsy: occurrence and clinical correlations.
Malformations of cortical development are commonly associated with epilepsy. In the first 139 consecutive patients in the Göteborg epilepsy surgery series, parenchymal malformations were found in 56. 1% of the children and in 23.1% of the adults. Microdysgenesis (MDG), which was the most common parenchymal malformation, was found in 35. 1% of the children and in 16.7% of the adults. The aim of this study was to identify clinical characteristics of patients with MDG. Mental retardation was found to be significantly more common in patients with major parenchymal malformations and in patients with MDG compared with patients without parenchymal malformations. Patients with major parenchymal malformations as well as patients with MDG also had a significantly earlier onset of seizures than patients without parenchymal malformations, also when adjusting for mental retardation. Patients with MDG were in these clinical aspects shown to closely resemble patients with major malformations. These findings suggest that MDG is a pathoanatomical entity of clinical relevance, with implications both in mental retardation and in epileptogenesis.
Adolescent↗
[Treatment of epilepsy must be improved. New antiepileptics and advanced surgery is needed].
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Anticonvulsants↗
Stimulation of forward locomotion by SCH-23390 and raclopride in d-amphetamine-treated rats.
In d-amphetamine-treated (4.0 mg kg(-1) s.c.) rats the selective dopamine D1 and D2/3 receptor antagonists SCH-23390 (2.5-20.0 microg kg(-1) s.c.) and raclopride (12.5-100.0 microg kg(-1) s.c.), respectively, produced a biphasic pattern of effects on forward locomotion, as observed in an open-field arena (approximately 0.5 m2). Thus, at the low doses of SCH-23390 (2.5-10.0 microg kg(-1)) or raclopride (12.5-50.0 microg kg(-1)), there was a statistically significant increase in forward locomotion, followed by suppression of the behavior at the higher doses. The SCH-23390-induced (5.0 microg kg(-1)) stimulation of forward locomotion was partially antagonized by concomitant raclopride treatment (12.5-25.0 microg kg(-1)) and the corresponding raclopride-induced (12.5 microg kg(-1)) stimulation was fully antagonized by treatment with SCH-23390 (2.5-5.0 microg kg(-1)). Furthermore, the SCH-23390- or raclopride-induced stimulation of forward locomotion was also antagonized by treatment with the alpha1-adrenoceptor antagonist prazosin (1.0 mg kg(-1) s.c.). These observations suggest that under conditions of an increased general tone at brain dopamine receptors, there is a mutual inhibitory synergy between dopamine D1 and D2/3 receptors.
Animals↗
[Surgical treatment is efficient in epilepsy].
Epilepsy surgery has a very long tradition, and recent advances in diagnostic and surgical procedures have enabled a number of patients with drug-resistant epilepsy to be treated successfully. In addition to the conventional clinical work-up, candidates for epilepsy surgery undergo evaluation by a multidisciplinary team using a battery of neuroimaging and neurophysiological procedures. Such teams have been established at all six university hospitals in Sweden.
Epilepsy↗
[Differential diagnosis in epilepsy. Anamnesis is still the most important guide].
Epilepsy is defined by the WHO as "a chronic brain disorder of various aetiologies characterised by recurrent seizures due to excessive discharge of cerebral neurones." There are many other episodic conditions including systemic, neurological and psychiatric disorders, which may be confused with epileptic seizures but are not the result of epileptic neuronal discharge. The principal differential diagnoses in cases of episodic seizures in adults and children are outlined in this review, and the importance of adequate history taking is stressed. Correct interpretation of the history is dependent upon the physician's recognition of the clinical features typical of epileptic seizures. Both the importance and the limitations of electroencephalography (EEG) are discussed. The contribution of EEG in cases where a diagnosis of therapy-resistant epilepsy has been questioned is exemplified in case studies of 42 patients, of whom 43 per cent were found to have psychiatric disease only, 26 per cent to have epilepsy only, 12 per cent to have both epileptic seizures and episodic symptoms of psychiatric origin, and the remaining 19 per cent to have episodic disorders of non-epileptic and non-psychiatric origin. The importance of adequate history taking before making a diagnosis of epilepsy is emphasised, as is the conclusion that an incorrect diagnosis of epilepsy often causes more harm than postponing the diagnosis until it becomes more clear.
Adult↗
[The Christmas gospel according to Milton: empty arguments on productivity].
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Efficiency↗
Prevalence of diabetic retinopathy in children and adolescents with IDDM. A population-based multicentre study.
Vision-threatening diabetic retinopathy can be prevented if it is diagnosed before becoming too advanced. Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development, children and adolescents are seldom included in screening programmes. We invited 780 children and adolescents with insulin-dependent diabetes mellitus diagnosed before the age of 15.0 years (disease duration of < 12 years) and who were older than 9.0 years at the time of examination from eight regions of Sweden. Retinal examination was performed with stereoscopic fundus photograph. The photograph were rated according to a modified Airlie House classification. The dropouts (223/780, 28.6%) were significantly older and with a longer duration of diabetes than the examined children (p < 0.001 and 0.001, respectively). Photographs from 557 patients aged (median [interquartile range]:14.6 [12.4-17.0]) years and with a diabetes duration of 8.0 (5.5-9.9) years were evaluated. Retinopathy was demonstrated in 81 patients (14.5%):66 with background retinopathy, 2 with microaneurysms and hard exudates, 12 with preproliferative retinopathy, 1 with proliferative retinopathy. Preproliferative retinopathy was diagnosed in a 12.8-year-old girl in pubertal stage 3 and an 11.8-year-old boy in pubertal stage 2, and proliferative retinopathy was found in a 21.5-year-old girl. Retinopathy was demonstrated in 6% and 18% of patients in pubertal stages 1 and 5, respectively. The overall prevalence of retinopathy in this population may even be higher since the dropouts were older and had a longer duration of diabetes. Since background and preproliferative retinopathy were found in children before puberty, we recommend including children and adolescents in screening programmes for diabetic retinopathy from the age of 10 years.
Adolescent↗