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Biomedical subjects

R W Homan

Publications and source records attributed to R W Homan.

12 recordsLinked to original sources
PubMed1992

Assessment of a computer program to detect epileptiform spikes.

This study compares an automated spike detection program to a group of 6 electroencephalographers. Since group members varied in experience, an expertise factor was devised to weight their scoring. EEGers underscored epileptiform events on 6 records in a manner analogous to the computer's storage of EEG segments. A summation of expertise factors was determined for every event. This sum was normalized and interpreted as a probability the event would be called a spike by a given EEGer. The performance of each scorer and of the computer at different amplitude thresholds was analyzed based on this probability. Higher rated scorers identified more subtle events. Lowering the threshold of the computer program produced a comparable increase in sensitivity. The increase in total events detected by the computer was linear over the range studied. While the proportion of false positive detections increased with lowering threshold, our readers have not found a moderate number of these distracting. We conclude that the computer system, while not as specific as an EEGer, can be as sensitive and can be a reliable screening editor for large amounts of monitoring data. On balance it is more effective than an EEGer for this limited purpose.

Electroencephalography↗
PubMed1990

Single photon emission computed tomography in epilepsy.

Functional brain imaging by either single photon emission computed tomography (SPECT) or positron emission tomography (PET) is now a well-established technique in the diagnosis and evaluation of the epilepsies. Perhaps only in stroke have these emerging technologies proven of greater significance. Scalp, cortical, or depth electroencephalographic (EEG) data previously have been the gold standards for the localization and subcharacterization of epileptic activity in the human brain. Yet, they are fraught with difficult interpretations, technical difficulties, and limitations in sampling accuracy. Both SPECT and PET have localizing power approaching that of combined scalp and depth EEG. In the following discussion, a brief overview of the results of PET investigations in epilepsy is presented as background and comparative material for the concurrent and, more recently, dominant role of SPECT in evaluating patients with seizure activity. SPECT results in the interictal state in partial and generalized seizure activity are reviewed followed by an analysis of the role of ictal SPECT imaging in epilepsy. Next, relationships among interictal hypoperfusion (or hypometabolism) and computed tomography, magnetic resonance imaging, neuropathology, clinical severity, and cognitive function are discussed. The role of perfusion or metabolism imaging in the management of antiepileptic pharmacotherapy is also discussed, and the potential for receptor imaging in the evaluation of the epilepsies is examined. Finally, application in pediatric epilepsy are presented.

Epilepsy↗
PubMed1989

Cognitive function and regional cerebral blood flow in partial seizures.

Patients with partial seizures have cognitive function impairments that have been attributed to the toxic side effects of anticonvulsants and structural cerebral damage. However, even when these factors are absent, neuropsychological (NP) deficits have been demonstrated, although of milder degree than in structurally brain-damaged patients. Assessment of cerebral metabolism using positron emission tomography and cerebral blood flow with single photon emission computed tomography (SPECT) reveals focal physiologic deficits in structurally normal areas. Using both SPECT and NP assessment with the Halstead-Reitan Battery, we evaluated 50 patients with partial seizures. Comparison of the location of visually identified regional cerebral blood flow (rCBF) deficits in these patients with the location of the NP deficits revealed a significant correlation. Additional analyses indicated that rCBF quantification in visually identified areas of hypoperfusion was significantly lower than in "normal" areas and that quantified NP variables significantly discriminated patients with and without visual rCBF deficits in temporal and frontal brain regions.

Adult↗
PubMed1989

Regional cerebral function and blood flow: complementary single photon emission computed tomography of the brain using xenon-133 and [123I]iodoamphetamine.

Regional cerebral function and blood flow can be imaged using isopropyl[123I]iodoamphetamine (IMP), or 133Xe (DSPECT), respectively. Both of these essentially non-invasive, quantitative, methods are suitable for many nuclear medicine laboratories. This study assessed the in vivo information about intracerebral disease provided by IMP and DSPECT techniques to determine the optimal diagnostic use of these modalities. Single photon emission computed tomograms of 53 subjects were acquired using similar displays for IMP and DSPECT data. Lobar tracer distributions were graded by three experienced observers and analyzed using a kappa statistic to eliminate chance agreements. Overall, both IMP and DSPECT had similar patterns. However, while similar, one or the other technique often displayed abnormalities not present on both. Although technical factors may account for some differences between the modalities, a case of arteriovenous malformation proves that discordant findings can result directly from tracer localization properties. Thus at least some discordances provide truly complementary diagnostic information lacking in either single study taken alone.

Adult↗
PubMed1989

Clinical utility of a Bayesian dosing program for phenytoin.

We performed two studies to assess the clinical utility of a Bayesian regression analysis computer program for phenytoin (PHT). In a randomized prospective study of 40 epileptic patients, the dosing program was significantly more accurate (p = 0.002) and less biased (p = 0.02) than a group of physicians at hitting a target PHT serum-concentration. Initial serum PHT concentrations that were not steady state were associated with the largest dosing errors by physicians but did not affect the accuracy of the dosing program. In a second study, we used the dosing program to predict 91 serum concentrations in 31 patients with PHT toxicity after the drug was stopped (initial concentration 26-69 micrograms/ml). The program predicted serum concentrations with a mean error of 3.49 +/- 0.29 micrograms/ml without significant tendency to over- or underpredict. We conclude that this dosing program may aid clinicians by improving dosing accuracy and predicting serum concentrations in patients with PHT toxicity.

Adolescent↗
PubMed1988

Anterior temporal electrodes in complex partial seizures.

Anterior temporal (AT) and sphenoidal (SP) electrodes as well as standard 10-20 electrodes were used to evaluate patients with recent onset complex partial seizures. A total of 58 epileptiform foci were found in 80 patients. AT electrodes significantly improved detection of foci in comparison with 10-20 electrodes. SP electrodes resulted in a small, non-significant increase in detection in comparison to AT electrodes. AT electrodes may be substituted for basal electrodes for the purpose of diagnosis in the majority of patients with recent onset complex partial seizures.

Electrodes↗
PubMed1988

Acoustic analysis of affective prosody during right-sided Wada Test: a within-subjects verification of the right hemisphere's role in language.

A within-subjects study of the affective characteristics of voice was carried out in patients undergoing a Wada Test (WT). All patients became densely aphasic after the left-sided WT and lost the ability to impart affect into speech after the right-sided WT. The affective changes in voice induced by the Wada test were acoustically analyzed by computer-assisted techniques and compared to data obtained pre-Wada and post-Wada. The statistical results, using a one-way analysis of variance for repeated measures, confirmed robustly the current view that the right hemisphere modulates dominantly the affective components of language. The results are also evaluated in light of recent clinical and acoustical data regarding the organization of language in speakers of tone languages, thus, allowing the authors to address issues concerning universal principles of brain-language-behavioral relationships.

Adult↗
PubMed1987

Cerebral location of international 10-20 system electrode placement.

We employed CT scanning to correlate scalp markers placed according to the international 10-20 system with underlying cerebral structures. Subjects were 12 normal volunteers. Measurements included assessment for cranial asymmetry to determine the effect of skull asymmetry on cortical location of electrodes. Results were correlated with the cortical histological map of Brodmann. Primary cortical locations agree well with previously published data and provide cortical localization in greater detail than previous studies. Variability of cortical electrode location was substantial in some cases and not related to cranial asymmetry. The results indicate that CT scanning or other neuroimaging techniques which reveal detailed cerebral anatomy would be potentially highly useful in defining the generators of electrocerebral potentials recorded from the scalp.

Adult↗
PubMed1979

Lorazepam in status epilepticus.

Lorazepam, a dichloro-3-hydroxy-1,4-benzodiazepine, has been shown to be a potent anticonvulsant in animal models of epilsepsy and has minimal depressant effects on respiration and circulation in humans. The effects of this compound were studied in status epilepticus. Twenty-five patients were given intravenous lorazepam during status epilepticus of varying cause. Four or 8 mg of the drug controlled status in 22 of the 25 patients. Although single seizures recurred in 5 of the 22 patients, none experienced recurrence of status during a prolonged follow-up period. Transient respiratory arrest occurred in 1 patient, but no other significant complications were observed. Studies of plasma drug levels suggest that most patients attain good seizure control at concentrations between 30 and 100 ng per milliliter. Clinical observations indicate that repetitive injections are not required for continuing control of seizures in patients whose seizures are initially controlled. Lorazepam appears to be an effective and safe drug for treatment of status epilepticus, with a duration of control longer than that achieved with diazepam.

Adolescent↗
PubMedDate not supplied

Kindled seizures elevate blood pressure and induce cardiac arrhythmias.

The effect of kindled seizures on the cardiovascular system was examined in amygdaloid kindled rats. The most prominent cardiovascular response during a generalized kindled seizure was an abrupt 50% increase in mean arterial pressure (MAP) lasting 20-30 s after initiation of the seizure. Superimposed on this change in blood pressure (BP) was a profound bradycardia characterized by a rate about half that recorded before stimulation. Changes in heart rate (HR) and BP observed during amygdaloid kindled seizures were similar to those observed during secondary spontaneous seizures. These effects apparently are independent of the kindling stimulus because stimulus-induced cardiovascular changes were not present at the beginning of the kindling process. These results suggest that the kindling seizure model is useful to study the underlying mechanisms of seizure-induced cardiac arrhythmias and possibly the clinical phenomenon of sudden unexplained death in epileptic patients.

Animals↗