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Biomedical subjects

R H Mattson

Publications and source records attributed to R H Mattson.

At least 109 records · Page 6Linked to original sources
PubMed1985

Episodic aphemia and epileptic focus in nondominant hemisphere: relieved by section of corpus callosum.

A patient had right hemiparesis since infancy. At age 31, she had recurrent right focal motor and sensory seizures. In prolonged focal seizures, she could not speak but retained most other language-related functions. Intracarotid cerebral amytal testing demonstrated right hemisphere speech. Left intracarotid amytal injection stopped a typical attack. Complete section of the corpus callosum abolished the aphemic episodes and reduced the frequency and intensity of the focal seizures. Focal seizure activity in the left nondominant hemisphere appears to have caused restricted functional disturbance in the right dominant hemisphere.

Adult↗
PubMed1985

Interhemispheric commissurotomy for congenital hemiplegics with intractable epilepsy.

Five patients with congenital hemiplegia and intractable epilepsy had interhemispheric commissurotomy (the split-brain operation). After intervals of 2 to 12 years, the response has been excellent in four cases. One patient had moderate benefit. There were no late complications. Commissurotomy seems to be substantially better than hemispherectomy for this syndrome.

Adolescent↗
PubMed1985

Monitoring at the West Haven VA/Yale University School of Medicine Epilepsy Center.

The Epilepsy Center of the West Haven VA Medical Center and Yale University School of Medicine was established in 1970. Nearly 2800 patients have been admitted and 130,000 h of EEG/video monitoring have been performed. Of the 300 annual admissions, over half are for diagnostic purposes and the majority of the remainder involve pre-surgical evaluation or post-surgical followup. Intensive monitoring at West Haven/Yale has been and continues to be based upon several fundamental concepts--continuous 24 h/day recording of EEG via cable telemetry, simultaneous video/audio recording of patient behavior, pen-written paper copy EEG for at least 24 h of the monitoring period, and around the clock capability for direct interaction with the patient to assess neurologic function. This maximal utilization has been possible because of a corps of specially trained nurses, who not only provide nursing care, but who can function as EEG technologists in their absence. Although pen-written EEG and multiplexed EEG recorded on video tape have been the monitoring mainstays at West Haven/Yale, ambulatory cassette and digitized computer recordings have recently been introduced. The resultant combined monitoring approach emphasizes the strengths of each technique and minimizes their weaknesses. The Epilepsy Center, its extensive patient population and a variety of talented personnel have formed a critical mass, the results of which have been numerous clinical investigations in the diagnosis and treatment of epilepsy.

Amplifiers, Electronic↗
PubMed1984

Selective memory improvement and impairment in temporal lobectomy for epilepsy.

Reexamination of 23 patients 1 year after elective anterior temporal lobectomy for intractable complex partial (psychomotor) seizures showed a reduction in certain memory functions combined with an improvement in others. Both improvement and impairment in selective memory functions were related to the degree of postoperative seizure reduction as well as to the side of the remaining temporal lobe. The results imply that uncontrolled seizures interfered with the memory functions of the temporal lobe contralateral to the epileptogenic focus.

Adult↗
PubMed1984

Occupational adjustment following neurosurgical treatment of epilepsy.

Occupational adjustment was investigated in a group of 32 adult epileptic patients followed for 1 to 10 years after cortical resection for intractable seizures. An employment status rating was assigned according to the following scale: (1) employed (working 75 to 100% of full time); (2) underemployed (25 to 74%); and (3) unemployed (0 to 24%). The number of patients employed increased from 14 to 23, whereas the number of underemployed decreased from 8 to 0. The unemployed group showed little change. An improvement or maintenance of employment status was correlated directly with improved postoperative seizure control. Conversely, poor occupational adjustment was often associated with fair or poor seizure control following operation. Unemployment was also related to the presence of preoperative psychiatric disorders, a history of past unemployment, and cognitive disturbances affecting nondominant hemisphere function. Although improvement in seizure control is important, this investigation suggests it is only one of many influences on the occupational adjustment of patients following surgical treatment of epilepsy.

Adolescent↗
PubMed1984

More intense focal seizure types after callosal section: the role of inhibition.

Corpus callosum section reduces the incidence of generalized seizures associated with loss of consciousness. Minimal data are available, however, regarding the types of seizures that may be present following surgery. Five of 17 patients in our clinic who underwent partial or complete corpus callosum section developed more intense and sometimes newly patterned (but not necessarily more frequent) focal seizures postoperatively. These patients were not predictably different from the other 12 in terms of age at onset of seizures or at surgery, cause of seizures, extent of callosum sectioned, radiographically demonstrable structural lesions, or the types of preoperative seizures. All 5 patients, however, had bilateral independent frontal electroencephalographic foci. No patients without these electroencephalographic findings developed more intense focal seizures after surgery. The findings are consistent with the results of experimental animal studies and argue for a suppressive influence of the contralateral hemisphere on some types of seizures.

Adolescent↗
PubMed1984

Preliminary observations on magnetic resonance imaging in refractory epilepsy.

We are studying the use of magnetic resonance (MR) imaging in localization of epileptogenic foci in patients with medically refractory partial epilepsy. Imaging is performed using a prototype resistive unit operating at 0.15 T. All studies include 7 mm axial sections obtained with a partial saturation sequence (TR = 200 msec) in which signals are recovered with a spin echo (TE = 11 msec) and images reconstructed using a modified 2D Fourier transform technique. Since the temporal lobe and limbic system are the commonest site of seizure foci in this group of patients, examinations were performed with the plane of section parallel to the temporal horns of the lateral ventricles. Consensus interpretations by a radiologist, neurologist and neurosurgeon have recognized findings considered possibly abnormal in six of 11 epilepsy patients and none of six normal volunteers. These preliminary results indicate that further study is warranted in this group of patients. Critical evaluation of such findings must be carried out in a larger group including normals and patients with a variety of neurologic disorders.

Adolescent↗
PubMed1984

Human serum teratogenicity studied by rat embryo culture: epilepsy, anticonvulsant drugs, and nutrition.

Epileptic women have a greater risk for spontaneous abortions and children with birth defects than do nonepileptics. In a unique approach to identifying causes of these problems, we have cultured whole rat embryos for 48 h on blood sera from epileptics. In the first part of the study, three embryos were cultured on each serum sample from 128 different epileptics being treated with either single anticonvulsants or no drug to compare the teratogenicity of these drugs. Sera from subjects receiving either phenobarbital or no drug had comparable frequencies of cultured embryo abnormalities, which were lower than those from subjects taking phenytoin, valproic acid, or carbamazepine. In the second phase of the study, attempts to identify causes for serum teratogenicity led to the finding that the abnormalities and reduced embryo growth produced by many serum samples could be completely overcome by adding vitamins and/or amino acids to the serum. Of 53 samples tested, 32 (60%) were corrected by supplementation (17 of 23 phenytoin, seven of nine phenobarbital, six of 12 carbamazepine, none of six valproic acid, and two of three no drug). Although the results of this study provided a general assessment of drug teratogenicity that agreed with other studies and emphasized the role of nutrition in fetal defects, the importance of individual differences in causes of teratogenicity was also noted.

Amino Acids↗
PubMed1984

Intracerebral masses in patients with intractable partial epilepsy.

One hundred ninety patients were considered for surgical treatment of uncontrolled partial seizures. Twenty-seven (15%) had intracranial mass lesions detected during preoperative evaluation. Seizures were present for a mean of 10 years. Sixty percent of the patients had prior negative radiologic studies. The lesions included 19 neoplasms and 8 non-neoplastic structural (non-atrophic) lesions. Refractory simple partial seizures and a changing neurologic examination were more commonly associated with neoplasms. Treatment included biopsy and radiation, mass resection, or subtotal lobectomy. Although any form of treatment gave better seizure control, patients undergoing subtotal lobectomy had more than 95% reduction in seizures.

Adolescent↗
PubMed1984

Treatment of seizures with medroxyprogesterone acetate: preliminary report.

Medroxyprogesterone acetate (MPA), a synthetic progesterone, was added to the antiepileptic drug regimen of 14 women who had uncontrolled seizures. Of the 11 women who developed amenorrhea, 7 reported fewer seizures during MPA therapy. Overall reductions in seizure frequency averaged 30% (n = 11), declining from a baseline 8.3 +/- 5.8 seizures per month to 5.1 +/- 4.1 seizures per month (p = 0.02). No serious side effects were encountered, but spotting was common. These preliminary data suggest further evaluation of MPA for catamenial seizures.

Epilepsy↗
PubMed1984

Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy.

The authors describe a surgical technique that allows access to the posterior temporal horn of the lateral ventricle with preservation of the most functional lateral temporal cortex. Development of the technique was stimulated by the need to resect posteromedial temporal lobe structures in patients with intractable complex partial epilepsy and well-identified unilateral posterior hippocampal foci. This technique has also been of value in the resection of some lateral ventricular and posteromedial temporal lobe masses. The operation consists of three steps. No more than 4.5 cm of the anterolateral temporal lobe is removed en bloc such that the most anterior aspect of the temporal horn is entered. An incision is carried from the floor of the temporal horn through the inferior longitudinal fasciculus to the middle fossa dura mater and posteriorally into the lateral ventricular atrium. The lateral temporal cortex and white matter are then elevated with a self-retaining retractor. This exposes the posteromedial temporal horn or intraaxial mass for excision or allows en bloc resection of the entire hippocampus and medial temporal lobe structures while preserving the functional association areas of the lateral temporal cortex, including speech and visual spatial function.

Epilepsy, Temporal Lobe↗
PubMed1983

A design for the prospective evaluation of the efficacy and toxicity of antiepileptic drugs in adults.

The design for the comparative evaluation of the efficacy and toxicity of phenobarbital, phenytoin, primidone, and carbamazepine is outlined. A double-blind prospective study of a sufficient number of patients can determine the optimum drug to use initially for partial and generalized tonic-clonic seizures in adults. The rationale for methods defines the major parameters that should be addressed in order to determine optimum drug for longterm seizure therapy. Major problems in the function of such a project include aspects of sample size attainment, screening/recruitment, non-drug-related losses, and adjustments to the ongoing protocol. The design, with modifications, can be used to study other antiepileptic drugs and other types of seizures.

Adult↗
PubMed1983

Sexual automatisms in complex partial seizures.

Ictal sexual automatisms such as masturbatory activity, pelvic thrusting, or similar automatisms for which the patient is amnesic have been attributed to temporal lobe disease. Of 61 patients with medically refractory complex partial seizures, 14 had frontal lobe seizure foci. Four of these patients manifested sexual automatisms in some or all of their seizures. Frontal lobe seizure origin was documented by depth EEG in three patients. In the fourth, a calcified lesion was demonstrated radiologically. In three patients, frontal lobectomy revealed abnormal frontal lobe pathology and was followed by 75 to 100% reduction in seizure frequency. Sexual automatisms did not occur in patients with seizures originating in any area other than the frontal lobe.

Adolescent↗