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Biomedical subjects

L Rumbach

Publications and source records attributed to L Rumbach.

107 records · Page 6Linked to original sources
PubMed1981

[Stuporous states during treatment with sodium valproate. Pathogenetic hypotheses].

In 11 patients with complex partial epileptic seizures stuporous states were observed during treatment with valproate (VPA) (2 cases), with VPA and phenobarbitone (PB) (4 cases), or with VPA, PB and a third anti-epileptic drug (5 cases). Based on 3 characteristic cases, an attempt is made to define the role of VPA, the nature of the stuporous states, and the origin of digestive disorders which often herald the onset of behavioural disorders. Several clinical studies have suggested the direct responsibility of VPA even if the adverse effects are potentiated by many other anti-epileptic drugs. Stuporous states are not due to VPA overdose and do not depend on the mode of administration. No correlation has been found between electroclinical signs and plasma or CSF levels of the different anti-epileptic drugs. Reported data and the present cases suggest a paradoxical epileptogenic role for VPA on complex partial seizures: there exists a close similarity of electroclinical findings between spontaneous epileptic seizures and stuporous states during DPA treatment. Digestive disorders appear to result from a central mechanism and not from digestive tract intolerance. In some cases, it is likely that partial seizures with digestive symptoms and signs do occur.

Adult↗
PubMed1981

[Stupor due to sodium valproate. Immediate arousal after intravenous diazepam (author's transl)].

A 7 year-old boy had had partial complex seizures from the age 6 years. Two days after commencing a treatment by VPA in a daily dose of 55 mg/kg body weight, disturbances of consciousness became obvious. He was admitted to hospital two days later. The E.E.G. on admission showed bilateral delta activity. The plasma levels of VPA was 140 mg/l. Diazepam, 7 mg, was given intravenously. Four minutes later, the clinical state and the E.E.G. returned to normal. This observation supports the hypothesis that VPA may have a paradoxical epileptogenic effect in some types of epilepsy.

Child↗
PubMedDate not supplied

Inhibition of oxidative phosphorylation in hepatic and cerebral mitochondria of sodium valproate-treated rats.

Rats were treated with intraperitoneal injections of sodium valproate (VPA), either acutely, one injection VPA 200 mg/kg, or chronically, VPA 600 mg/kg/day for 5 days, and the oxygen consumption, MO2, of isolated hepatic and cerebral mitochondria measured. For hepatic mitochondria, Stade IV MO2 decreased by more than 20%, and Stage III MO2 by more than 50%, in the presence of succinate or glutamate-malate substrates. A decoupling agent intensified this inhibition. With cerebral mitochondria, the effects were similar but weaker, for pyruvate-malate or glutamate-malate substrates. These findings suggest that VPA, a short-chain fatty acid, may affect the properties of the internal mitochondrial membrane, although an action on substrate carriers, or on indispensable mitochondrial metabolites, is not excluded. Inhibition of oxidative phosphorylation cannot, however, alone account for hepatotoxicities seen in VPA-treated subjects. These are rare, whereas inhibition of mitochondrial respiration by VPA is consistently observed.

Adenosine Diphosphate↗
PubMedDate not supplied

Auditory event-related potentials in obstructive sleep apnea: effects of treatment with nasal continuous positive airway pressure.

Event-related potentials (ERPs) were recorded in 47 patients with obstructive sleep apnea (OSA) syndrome prior to and after 6 weeks of treatment with continuous positive airway pressure (CPAP). Compared with a control group, the OSA patients showed ERP abnormalities: lengthened P3 latencies and decreased N2-P3 amplitudes. After 6 weeks of CPAP treatment, there was a highly significant improvement in the abnormal ERPs: the P3 and N2 latencies were shortened, but remained longer than in controls, and the N2-P3 and N1-P2 amplitudes were increased. No correlations could be established with various sleep variables. ERPs may be used as an electrophysiological marker of brain dysfunction; treatment of OSA with CPAP is probably responsible for functional brain modifications. On the other hand, possible relationships between the ERP abnormalities and the neuropsychological disorders observed in OSA remain to be established.

Adult↗
PubMedDate not supplied

Role of a stroke data bank in evaluating cerebral infarction subtypes: patterns and outcome of 1,776 consecutive patients from the Besançon stroke registry.

UNLABELLED: The purpose of this study was to estimate the frequency of various risk factors, courses and outcome of infarct subtypes in a large hospital-based stroke registry. METHODS: From 1987 to 1994, 1,776 stroke patients with a first-ever infarction were included in the Besançon Stroke Registry. All patients were evaluated by a standard protocol (risk factors, stroke onset, stroke courses, clinical characteristics, neuroimaging, Doppler ultrasonography and cardiac investigations). Outcome was evaluated at 30 days using the Rankin scale. RESULTS: There were 1,012 men (mean age 67.2 +/- 13.7 years) and 764 women (mean age 71.4 +/- 15.6 years). At least two neuroimaging examinations were performed in 81.4% (n = 1,446) of the patients and an infarct was visible in 80.9% (n = 1,436). The second neuroimaging examination (CT or MRI) was performed after 8.2 +/- 1.6 days. 85.4% of patients were admitted on the first day of the stroke: 28.3% within 3 h and 48.4% within 6 h. In addition, stroke severity was well correlated with the short time interval between stroke onset and admission. Past medical history of hypertension was the major risk factor occurring in 57.5% of all types of infarction. While diabetes was more frequently found in small deep infarct, atrial fibrillation and history of heart failure were found in anterior circulation infarcts. The distribution of clinical presentations was conventional. Hemorrhagic transformation was found in 14.9% of the patients, especially in MCA and PCA infarcts. In all patients, logistic regression analysis determined independent predictive factors for death: clinical deterioration at the 48th hour (OR 7.5, 95% CI 4.9-11.3), initial loss of consciousness (OR 3. 3, 95% CI 2.1-4.9), age (OR 1.05, 95% CI 1.03-1.06), complete motor deficit (OR 2.6, 95% CI 1.7-3.8), history of heart failure (OR 1.9, 95% CI 1.3-3.0), lacunar syndrome (OR 0.25, 95% CI 0.10-0.60) and regressive stroke onset (OR 0.24, 95% CI 0.10-0.52). However, the outcome was clearly correlated with the infarct location. The in-hospital mortality rate was lowest in patients with small deep infarct (2.9%) or border zone infarcts (3.4%) and the highest in patients with total middle cerebral artery infarct (47.4%) or multiple infarcts (27.6%). CONCLUSION: Our registry appears to be a useful tool to understand the course and outcome of a large group of nonselected patients with subtypes of infarction. It can also help to analyze the influence of specific stroke management in the different categories of stroke types.

Aged↗
PubMedDate not supplied

[Open therapeutic trial of anti-T CD4 monoclonal antibody in multiple sclerosis].

Twenty-one patients with active multiple sclerosis (16 progressive and 5 recurrent forms) were treated with murine monoclonal anti-T CD4/BF5 antibodies in an open trial. Tolerance was relatively good; 11 patients had side effects including facial swellings, skin eruptions and trembling which occurred only at the first infusion. Treatment had to be stopped in one female patient. Nine months after initiating treatment, no relapse had occurred in any of the 5 patients with a recurrent form and improvement was observed in 3 patients with a progressive form. At the end of the treatment period, there was a clear drop in the number of CD3+ cells and particularly in CD4+ cells, a decrease which was less after one month. All the patients who had side effects showed an increased level of serum IL6 and alpha TNF. These findings demonstrate that this type of long-term treatment is possible in patients with multiple sclerosis and suggest that in another trial it would be important to evaluate the effect in recurrent forms.

Adult↗