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Biomedical subjects

M Ossemann

Publications and source records attributed to M Ossemann.

At least 19 recordsLinked to original sources
PubMed2005

Prophylaxis of the epilepsies: should anti-epileptic drugs be used for preventing seizures after acute brain injury?

In many circumstances antiepileptic drugs are used in patients who have never presented any clinical epileptic seizures. These substances are administered on the assumption of a potential risk for the patients of developing acute or delayed chronic seizures after brain injuries such as trauma, stroke, hemorrages or even neurosurgical interventions. The aim of this paper is to propose therapeutic guidelines for the management of this prophylactic attitude in epilepsy based on basic research and clinical practice in the French community in Belgium. We will distinguish between the prevention of acute (early onset-provoked) seizures and a delayed truly post-lesional (unprovoked) epilepsy. Some therapeutic goals can be achieved under the former circumstances whereas in the latter situation we all agree for the absence of any coherent antiepileptic prophylactic behaviour.

Acute Disease↗
PubMed2005

Guidelines for recognition and treatment of the psychoses associated with epilepsy.

Epilepsy and psychiatric diseases are frequent comorbidities. Psychoses in patients with epilepsy have special physiopathology and several clinical presentations and prognoses. Their treatments are also specific, according to the specific diagnosis. This paper represents the summary of a consensus meeting held in November 2003 by a Belgian French-speaking group of neurologists, neuropediatricians and psychiatrists and proposes guidelines for the recognition and treatment of those entities.

Antipsychotic Agents↗
PubMed2004

Hypnic headache: a case report with polysomnography.

We report on a case of nocturnal headache attacks fulfilling the criteria for hypnic headache syndrome. Using an overnight polysomnography, one nocturnal headache attack was captured during the REM phase of sleep. Quality of sleep was poor with desaturation episodes. However, the hypnic headache attack was not associated with oxygen desaturation. This additional case supports the view of a relationship between the hypnic headache syndrome and the REM sleep stage. Lithium therapy decreased the intensity and frequency of headache attacks.

Diagnosis, Differential↗
PubMed2003

Therapeutic issues in women with epilepsy.

Approximately 20% of people with epilepsy are of childbearing potential and about 3 to 5 births per thousand will be to women with epilepsy. Both epilepsy and antiepileptic drugs can cause specific problems in women and embryos (less than 8 weeks of gestational age) or foetuses (more than 8 weeks of gestational age). The aim of this paper is to discuss therapeutic issues for the management of women with epilepsy: initiation of antiepileptic therapy, contraception, pregnancy, breast feeding and menopause. Some fertility issues are also discussed.

Anticonvulsants↗
PubMed2002

Therapeutic strategies in the choice of antiepileptic drugs.

The choice of treatment of newly diagnosed epilepsy involves many factors such as age, sex, life style, general health and concomitant medication. The seizure type, syndrome, and the pharmacology, efficacy and safety of the antiepileptic drugs (AEDs) should also be considered. Some of the new AEDs appear to provide at least equivalent efficacy with better tolerability. Some of these drugs have the potential to become drugs of first choice in newly diagnosed epilepsy. At the present time, we also must consider the criteria of reimbursement of these drugs. In this paper, we try to describe common and practical strategies to start a treatment of newly diagnosed epilepsy.

Anticonvulsants↗
PubMed2001

[Clinical and pathophysiological contribution of event-related potentials used to study migraine headache].

Event-related potentials are electric brain manifestations evoked by mental activities. This neurophysiological technique is able to describe temporal succession of cognitive processing and allows to measure the neurobiological correlates of each cognitive activity. The evoked potentials of the oddball paradigm and the Contingent Negative Variation (CNV) are also concerned by clinical applications in neuropsychiatry, in neurology and in psychopharmacology. In the case of migraine, the studies with CNV recorded between migraine attacks are characterized by two major phenomena, cerebral hyperreactivity and lack of habituation to repetitive stimuli. From cognitive point of view, this can be interpreted as a difficulty from migraine sufferers to adapt their information-processing to environmental constraints. From neurological point of view, this trouble is related with dysregulation of norepinephrin and serotonin ascending pathways. Studies with the oddball paradigm potentials remain non consistent. The mismatch between different methodologies could explain such a lack of consistency. The neurophysiological studies have contributed to new physiopathological hypothesis of migraine. Those hypothesis reveal that a shift in the brain metabolic homeostasis could be the common factor of migraine attacks. The clinical contribution of event-related potentials is of little use in the diagnosis of migraine. But two purposes have been suggested: the differential diagnosis between common migraine and tension-type headaches and the monitoring of beta-blocking agents prophylaxis.

Brain↗
PubMed2001

Discrepancy between diffusion and perfusion imaging in a patient with transient ischaemic attack.

We report paradoxical and ambiguous imaging findings in a patient with transient ischaemic attack (TIA). Perfusion-weighted (PW) MRI obtained 2 hours after symptoms onset showed a hypoperfused area in a region compatible with the focal deficit, while diffusion-weighted (DW) MRI was considered negative. Despite the complete resolution of the symptoms which had already begun at the end of the first MR examination, follow up DW MRI at 3 days showed partial conversion to hyperintensity of the initially hypoperfused area. This case illustrates that PW and DW MRI have to be used in combination and at different time points to correctly diagnose and manage ischaemic stroke because PW MRI is more sensitive than DW MRI for very early detection of ischaemia and delayed DW MRI provides the final signature of brain damage even in case of complete clinical recovering.

Cerebrovascular Circulation↗
PubMed2001

[Identification of factors influencing hospital admission delay after ischemic cerebrovascular stroke. Study of a rural population].

We studied the time of arrival of 235 consecutive patients admitted to the emergency department of a University Hospital located in a rural area after the first symptoms of ischemic stroke or TIA. Among the following factors, we determined those that might be involved in delayed admission: place of symptom onset, time and place of onset of the first symptoms, contact with a general practitioner before admission time, mode of transportation, clinical score, impairment of consciousness, presence of seizures, heart complaints or headache, age and past medical history of cerebrovascular, cardiovascular and hypertension diseases. Half of the patients arrived within 4 h 10 of symptom discovery and 55 p. cent arrived within 6 hours. The percentage of patients arriving within 3 h (p = 0.001) and 6 h (p = 0.001) was higher for those who had a stroke during the day (8 a.m.-8 p.m.) than during the evening and night. The other characteristics associated with a shorter delay included a low neurological score on the Mathew's Stroke Scale (p < 0.001 at 3 h and p = 0.001 at 6 h) and younger age (p = 0.015 at 3 h). Presence of headache delayed admission (p = 0.010). Forty-five percent of patients arrive at the hospital 6 hours after the discovery of symptoms, too late to receive optimal stroke therapy. Widespread public education on stroke is necessary to reduce the delay of admission, particularly for old patients and in case of mild to moderate deficits.

Adolescent↗
PubMed2000

Hypoplasia of the internal carotid artery: a noninvasive diagnosis.

We present the characteristic imaging findings of hypoplasia of the internal carotid artery (ICA) in two cases, one accompanied by an intracranial aneurysm. Finding of a diffuse luminal narrowing of the ICA on MR angiography or digital subtraction angiography (DSA) could wrongly evoke severe acquired diseases such as dissection or atherosclerosis. Absence of associated wall thickening and flow disturbances on color Doppler sonography (CDS) should suggest carotid hypoplasia. Confirmation of the diagnosis is obtained by CT of the skull showing a small carotid canal. Non-invasive procedures are sufficient to differentiate this rare congenital anomaly from acquired string signs.

Aged↗
PubMed1996

[Tropical spastic paraparesis due to HTLV-I. 4 case reports and literature review].

We describe the clinical, radiological, neurophysiological and biological characteristics of 4 patients suffering from tropical spastic paraparesis due to a HTLV-I infection. Patient 1 immigrated in Europe at the age of 16 from Caribbean islands. Patient 2 was a White male Caucasian who lived during several years with a prostitute also native of Caribbean islands. Patient 3 was a Black male Zaïrian and Patient 4 was a female of mixed race who lived many years in Zaäire and in Senegal. All the 4 patients presented with walking difficulties, a spastic paraparesis, urinary disturbances and often, severe constipation. The diagnosis was based on a positive ELISA test for HTLV-I antibodies, confirmed in 2 cases each by Western blots and detection of the viral genome by the Polymerase Chain Reaction. In all cases, CSF pleocytosis and CSF-restricted oligoclonal IgG bands were observed. MRI of the spinal cord showed a global atrophy in 3 cases. Cerebral MRI revealed unusual extensive, progressive and symmetric lesions of the white matter in Patient 1, and some patchy periventricular lesions in Patient 4; this examination was normal in the two other cases. Sensory evoked potentials indicated abnormalities of central conduction velocities at the level of the posterior columns. The pathogenesis of tropical spastic paraparesis is briefly discussed.

Aged↗