Biomedical subjects

R H Mattson

Publications and source records attributed to R H Mattson.

148 records · Page 9Linked to original sources

PubMedDate not supplied

Behavioral toxicity associated with antiepileptic drugs: concepts and methods of assessment.

The BTB designed for the VA Epilepsy Cooperative Study is a conceptually organized and practical set of test procedures that can be utilized to assess change in the areas of motor integration, visual perception, speech and language, and mood that might be attributable to AED therapy. If the data warrant, these categories can be compressed into motor, attention-concentration, and mood. The unique methodological advantages of the VA Epilepsy Cooperative Study provide an opportunity to determine empirically the occurrence of behavioral toxicity for specific AED. The advantage of the BTB is the capacity to measure change from an objective baseline over an extended period during chronic AED treatment. The disadvantages are the requirements for apparatus, trained technicians, and additional time for the patient, which now limit its use to research. If BTB data confirm its sensitivity to behavioral toxicity often unappreciated during a neurological exam, the BTB will become a useful clinical tool. Additionally, a common vocabulary for communicating behavioral toxicity may emerge. This optimistic picture is presented with the simultaneous acknowledgment that a clear solution to the problem lies in accumulation of data in future studies which will have had the opportunity to examine the forthcoming results of this multicenter study.

Anticonvulsants↗

PubMedDate not supplied

Behavioral characteristics of epilepsy patients compared with normal controls.

Using neuropsychological testing procedures, we measured the behavioral characteristics of patients with epilepsy unaffected by anticonvulsant drugs and compared these results with control subjects matched for age, sex, and education. In a nationwide VA Cooperative study, 622 patients with well-defined seizure types were given a selected battery of neuropsychological tests prior to and at 1 month after initiation of drug therapy. Seventy-four control subjects were administered the same test battery under standardized conditions at the same VA testing centers. All tests of controls were also repeated 1 month later. The patients with epilepsy scored significantly and consistently below the level of the control subjects on all but three behavioral measures. Differences reaching statistical significance were found on tests of motor function (Finger Tapping, Pegboard, Color Naming), cognitive-attention (Digit Symbol, Discriminative Reaction Time, Word Fluency), and subtests of the Profile of Mood Status (tension, depression, vigor, and confusion). These data provide a profile of behavioral characteristics of unmedicated patients with epilepsy.

Adolescent↗

PubMedDate not supplied

Human hippocampal seizure spread studied by depth and subdural recording: the hippocampal commissure.

Eleven patients had seizures with unilateral temporal lobe onset recorded with simultaneous bilateral medial temporal depth electrodes and neocortical (subdural) electrodes at least on the side of seizure onset. Of a total of 55 seizures, four had simultaneous onset in neocortex and hippocampus, and 51 had onset in unilateral hippocampus. None originated solely in temporal neocortex. Three reproducible patterns of seizure spread from hippocampus were defined in which seizures spread initially to ipsilateral neocortex (32 seizures), spread first to contralateral hippocampus (13 seizures), or spread simultaneously to ipsilateral neocortex and contralateral hippocampus. Although the region of hippocampus in which seizures arose was constant, patterns of spread sometimes varied in the same patient. When contralateral neocortical involvement occurred, it was after or with contralateral hippocampus but never before. These results suggest the existence of an operational hippocampal commissure in humans.

Electroencephalography↗

PubMedDate not supplied

Intracranial, intraaxial, space-occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgical correlation.

Fifty of approximately 250 patients evaluated for intractable partial seizures were shown to have a space-occupying lesion detected with radiographs and/or neuroimaging. Twenty-eight males and 22 females had a mean age at seizure onset of 13 years and a mean duration of seizures of 11 years. All patients had closed-circuit television with EEG monitoring and complete neurologic and neuropsychological assessment. Findings were correlated with lesion location and surgical data. Twenty-seven lesions (54%) were located in the temporal lobe. Thirty-five lesions (70%) were neoplastic. All patients with temporal lobe lesions had complex partial seizures, as did 74% of patients with extratemporal lesions. A good correlation between clinical seizure characteristics and lesion localization was found with the temporal, occipital, and frontal lesions but not with the parietal lesions. Sixty-six percent of patients had focal interictal EEG findings. Lateralization corresponded to the side of the lesion in 64% and was localized to the region of the lesion in 30%. Lateralized ictal EEGs occurred in 58% of patients, corresponding with the side of the lesion in all but one patient. Abnormal findings on neuropsychological testing were congruent with lesion lateralization in 56% of patients and were localized to the region in 26%. Thirty-nine of 47 patients who underwent a subtotal lobectomy to include the lesion are seizure-free after greater than or equal to 1 year of follow-up, and five others are markedly improved.

Brain↗