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Biomedical subjects

M R Trimble

Publications and source records attributed to M R Trimble.

At least 55 records · Page 3Linked to original sources
PubMed1999

Patterns of brain activity in patients with epilepsy and depression.

Depression is a recognized feature of epilepsy. This study tested the hypothesis that depression arising in patients with epilepsy would be associated with decreased activity in brain regions previously demonstrated to be hypoperfused both in primary depression and in depression secondary to movement disorders. Two groups of patients with temporal lobe epilepsy were studied, one of which also met DSM IV criteria for a major depressive episode. All underwent a SPECT scan using the blood flow marker,(99m)Tc-HMPAO. An automated voxel-based analysis demonstrated no regions of relatively decreased activity in the depressed compared with the non-depressed patients. Sites of relative hyperactivity in the depressed group were concentrated in the left hemisphere, particularly in dorsolateral prefrontal cortex, striatum, thalamus and temporo-parietal regions. Comparison of these data with normal population data revealed that in the depressed epilepsy group regional activities were within the normal range whilst corresponding results from the non-depressed group were below it. Depressed patients with epilepsy have cerebral regions with greater perfusion than non-depressed people with epilepsy, although they are not hyperperfused compared with normals. Our results suggest that depression in people with epilepsy may arise from a mechanism which differs from that underlying the development of depression in patients with movement disorders.

Adult↗
PubMed1999

Forced normalization: clinical and therapeutic relevance.

The phenomenon of forced normalization and its clinical counterpart, alternative psychoses, is discussed. The historical origins are briefly noted before the clinical presentation, and some associated clinical findings are given. The main part of the article is devoted to the literature on chemical and electrical kindling, in an attempt to provide some heuristic model to understand the antithetical relationship between seizures and behavior disorders. We conclude that the use of the kindling model may provide further insights into these phenomena, particularly taking into account such key neurotransmitters as glutamate, dopamine, and GABA.

Animals↗
PubMed1998

Adjunctive therapy in epilepsy with new antiepileptic drugs: is it of any value?

A total of 97 patients were recruited into a prospective, follow-up study after they were prescribed an adjunctive antiepileptic drug. The patients were followed up over a 6-month period. The interview included questions on Quality of Life, side-effects, adverse events and seizure frequency and severity. We operationally defined patients 'satisfaction' as (i) still on new drug; (ii) experiencing no side-effects (iii) experiencing no adverse events and (iv) had a greater than 50% reduction in seizures. A total of 13 patients (17%) reported being 'satisfied' according to our operational definition.

Acetates↗
PubMed1998

A prospective study of the early postsurgical psychiatric associations of epilepsy surgery.

OBJECTIVES: To examine prospectively the frequency and nature of psychiatric symptoms seen in patients during the first three months after temporal lobe surgery for chronic intractable epilepsy and in addition to study the relation between presurgical mental state, laterality of surgery, and postsurgical seizure and psychiatric course. METHOD: A consecutive series of 60 patients being assessed for temporal lobe surgery for intractable epilepsy were studied. They were interviewed before surgery and at six weeks and again at three months after operation. RESULTS: At six weeks after surgery half of those with no psychopathology preoperatively had developed symptoms of anxiety or depression and 45% of all patients were noted to have increased emotional lability. By three months after surgery emotional lability and anxiety symptoms had diminished whereas depressive states tended to persist. Patients with a left hemispheric focus were more likely to experience persisting anxiety. CONCLUSION: The early months after surgery for epilepsy are characterised by the relatively common presence of psychiatric symptoms. It is proposed that presurgical and early postsurgical neuropsychiatric involvement in programmes of surgery for epilepsy will help to improve the quality of the treatment package offered to patients.

Adolescent↗
PubMed1998

New antiepileptic drugs and psychopathology.

The literature on the effects of anticonvulsant drugs on behaviour is reviewed, with particular attention to the new agents. Positive psychotropic effects, and negative influences on behaviour are noted. The latter include depression and psychoses. The drugs most involved seem to be those with GABAergic properties, and the role of forced normalisation is discussed.

Anticonvulsants↗
PubMed1997

Psychiatric profiles and patterns of cerebral blood flow in focal epilepsy: interactions between depression, obsessionality, and perfusion related to the laterality of the epilepsy.

OBJECTIVES: In a study of patients with focal epilepsy the hypothesis was explored that different measurements of psychopathology are related to specific distributions of cerebral perfusion. METHODS: Forty patients had SPECT performed with (99m)Tc-HMPAO. In addition, patients received a psychiatric evaluation with the following psychiatric questionnaires: the Beck depression inventory, the Leyton obsessionality inventory, the Bear-Fedio questionnaire, and the social stress and support interview. Patients were analysed in two groups according to the laterality of the epilepsy. Nine patients were excluded based on poor quality scans (n = 1), unlateralised epilepsy (n = 4), and left or ambidextrous handedness (n = 4). RESULTS: There were no overall differences between the left and right epilepsy groups on measures of psychopathology. Associations were found between scores on some of the rating scales and regional cerebral blood flow. Specifically, for patients with left sided epilepsy, higher scores on the Beck depression inventory were associated with lower contralateral temporal and bilateral frontal perfusion, and higher occipital perfusion. For patients with right sided epilepsy higher scores on the Leyton obsessionality inventory were associated with increased perfusion in ipsilateral temporal, thalamic, and basal ganglia regions and bilateral frontal regions. CONCLUSION: The results do not support the notion that lateralised epileptogenic lesions are associated with different levels of depression, obsessionality, or personality traits. They support the view that certain psychopathological symptom patterns are related to specific regional dysfunctions depending on the laterality of a hemispheric lesion.

Adolescent↗
PubMed1997

Neuropsychiatric symptoms from the temporolimbic lobes.

Neuropsychiatric symptoms are common manifestations of temporolimbic lesions. These neuropsychiatric symptoms result from disturbances of specific temporolimbic networks, including medial limbic circuits, lateral limbic circuits, and the "extended" amygdala. Moreover, temporolimbic networks interface with multiple cortical and subcortical circuits that modulate emotional behavior and affect. This article not only reviews these behaviorally relevant aspects of temporolimbic neuroanatomy, but also describes positive, productive symptoms from the temporal lobes. The Klüver-Bucy syndrome, the Gastaut-Geschwind syndrome, emotional or mood disorders, delusions, anxiety and associative disorders, and neurovegetative symptoms are discussed, as well as amnesia, the signature temporolimbic disturbance of cognition. The temporolimbic lobe is a classic example of a widely distributed circuit within the brain that has behaviorally relevant manifestations.

Brain Diseases↗
PubMed1997

A volumetric MRI study of Gilles de la Tourette's syndrome.

The neuroanatomic or neuropathologic basis of Gilles de la Tourette's syndrome (GTS) remains unknown. Recent studies have suggested abnormalities of cerebral asymmetry and basal ganglia volumes. We studied 17 patients with GTS and eight normal controls using volumetric MRI techniques for measuring the caudate nucleus, amygdala, and corpus callosum. One subject with GTS was subsequently excluded because he was left handed. No absolute differences in caudate nucleus volumes between patient and control groups were evident. There was an increase in corpus callosum (CC) cross-sectional area and a loss of the normal asymmetry of the caudate nucleus in the patient group. A loss of the normal correlation between cross-sectional area of the CC and whole brain index (WBI) in the patient group also was found. The amygdala measurements had a poor interrater reliability.

Adolescent↗
PubMed1996

The use of fluoxetine in Gilles de la Tourette syndrome and obsessive compulsive behaviours: preliminary clinical experience.

1. Obsessive Compulsive Behaviours (OCB) occur in more than 50% of patients with the Gilles de la Tourette Syndrome (GTS) and in some cases these behaviours are more disabling than the tics themselves. 2. Fluoxetine, a specific serotonin reuptake inhibitor (SSRI) has been demonstrated to be effective in patients with Obsessive Compulsive Disorder. 3. The authors report on their clinical experience of fluoxetine in 30 GTS patients with OCB, in an open retrospective study. 4. There was an overall improvement in OCB as judged by the clinician in 76% of cases. Most patients received fluoxetine at a daily dose of 20 to 40mg for an average period of 6 months (24 +/- 4 weeks). In general, fluoxetine was well tolerated and further studies are indicated.

Adolescent↗
PubMed1996

HMPAO SPECT in non-epileptic seizures: preliminary results.

The diagnosis of non-epileptic seizures (NES) is problematic. Although diagnosis can be achieved by videotelemetry, these facilities are expensive and not widely available. HMPAO SPECT studies show focal hypoperfusion interictally in focal epilepsy. SPECT has not been studied in any detail in NES previously. Two groups (10 patients each) were studied, one with NES and one with complex partial seizures and localisation related epilepsy. SPECT scans were normal in 7 of 10 (70%) NES patients, while showing clear focal hypoperfusion in 8 of 10 patients (80%) with epilepsy. In the NES group, 1 patient showed hypoperfusion indistinguishable from that seen in epilepsy, while 2 patients in the epilepsy group showed only equivocal focal hypoperfusion. The remaining 2 patients in the NES group showed bifrontal and equivocal focal hypoperfusion. A normal HMPAO SPECT study supports the diagnosis of NES in patients with seizures of uncertain aetiology.

Adolescent↗
PubMed1996

Ten-year prognosis of conversion disorder.

BACKGROUND: Previous work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected. METHOD: Clinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services. RESULTS: Thirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up. CONCLUSIONS: The prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.

Adaptation, Psychological↗
PubMed1996

Anticonvulsant-induced psychiatric disorders. The role of forced normalisation.

With the introduction of several new anticonvulsant drugs into clinical practice in recent years, renewed attention has been paid to treatment-emergent effects, especially behavioural syndromes. In this review, the more severe psychiatric syndromes that may be associated with anticonvulsants are discussed, especially personality disorders, affective syndromes and psychoses. The important concept of forced normalisation is discussed, and its clinical counterpart, alternative psychosis. Affective disorders and psychoses have been described as associated with most of the new anticonvulsant agents, and they are often seen in a setting in which previously intractable patients suddenly become seizure free. Other cases may relate to intoxication, the precipitation of a status epilepticus, or ensue as part of the background frequency of those syndromes that are seen in epilepsy irrespective of medication.

Anticonvulsants↗
PubMed1995

Optimised interictal HMPAO-SPECT in the evaluation of partial epilepsies.

Interictal blood flow single photon emission computed tomography (SPECT) has been considered to be of limited value in the investigation of patients with partial epilepsies. Newer SPECT technologies using brain dedicated multiple detector systems have not been fully evaluated. To study the usefulness of an optimized SPECT technique, we scanned 40 epilepsy patients and ten normal subjects. Interictal [99mTc]hexamethylpropylene amine oxime (HMPAO) SPECT scans were acquired using the GE/CGR Neurocam triple-headed brain-dedicated system. The results of a qualitative analysis of the scans were compared to EEG and optimised MRI findings. Eight of the normal subjects and one of 40 patients had normal SPECT scans. There was a comparable concordance of lateralization between SPECT, MRI and EEG. The majority of our patients had mesial temporal pathology on MRI. Perfusion abnormalities extending beyond the mesial temporal area were common and did not simply relate to structural abnormalities. Quantification of blood flow in multiple brain regions revealed that hypoperfusion did not occur at random. Perfusion in the mesial temporal lobe was related to perfusion in anatomically and functionally related ipsilateral and contralateral brain regions. These hypoperfused areas probably reflect dysfunctioning areas which are related to the epileptogenic process.

Adult↗
PubMed1995

Carbamazepine and PIP-syndrome in temporal lobe epilepsy.

We describe four patients with left temporal lobe epilepsy who developed psychosis, intermittent polydipsia and hyponatremia (PIP-syndrome) while being treated with carbamazepine. These cases illustrate the close links between dysfunction of the limbic system causing epileptic seizures and psychosis on the one hand and dysregulation in hypothalamic centers manifestating in polydipsia and osmodysregulation on the other.

Anticonvulsants↗
PubMed1995

Adjunctive therapy in epilepsy: a cost-effectiveness comparison of alternative treatment options.

A pharmaco-economic study of the administration of adjunctive therapy in patients with chronic epilepsy is described. A decision-analytic model has been used, which represents the consequences of treatment over a 1-year time period, when one of three drugs is used first. The cost-effectiveness ratio for clobazam, lamotrigine and vigabatrin have been calculated. The expected cost per patient of treatment over the 1-year period was up to 50% higher with vigabatrin and lamotrigine compared with clobazam, with a cost-effectiveness ratio around 40% higher.

Acetates↗