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Biomedical subjects

W A Hauser

Publications and source records attributed to W A Hauser.

At least 127 records · Page 7Linked to original sources
PubMed1990

Status epilepticus: epidemiologic considerations.

Status epilepticus (SE) will occur in 50,000 to 60,000 individuals in the United States annually: one third as the presenting symptom in patients with a 1st unprovoked seizure or with epilepsy, one third in patients with established epilepsy, and one third in individuals with no history of epilepsy. The greatest number of cases will occur in children, although the risk is equally high in the over-60 population. In patients with epilepsy, SE is more likely to occur in those with partial seizures and in those with remote symptomatic epilepsy. The presence of a preexisting neurologic abnormality is associated with an increased risk of SE in those with acute systemic insults. There is a high mortality reported, but this is related predominantly to the underlying condition. The 1 to 2% mortality attributed to SE probably reflects an overestimation of the risk. There is an increased risk of seizures and of intellectual dysfunction following the occurrence of an episode of SE, although the causal association is not clear. Individuals with epilepsy who experience an episode of SE probably have a lower likelihood of remission of epilepsy.

Brain Diseases↗
PubMed1990

Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study.

In a prospective study, 283 children who presented with a first unprovoked seizure were followed for a mean of 30 months from the time of first seizure. Subsequent seizures were experienced by 101 children (36%). The cumulative risk of seizure recurrence for the entire study group was 26% at 12 months, 36% at 24 months, 40% at 36 months, and 42% at 48 months. The cumulative risk of recurrence in the 47 children with a remote symptomatic first seizure was 37%, 53%, and 60% at 12, 24, and 36 months, respectively, compared with a cumulative risk of 24%, 33%, and 36% at 12, 24, and 36 months, respectively, in the 236 children who had had an idiopathic first seizure (P less than .01). In children with an idiopathic first seizure, the electroencephalogram was the most important predictor of recurrence. The cumulative risk of recurrence in the 81 children with abnormal electroencephalograms was 41%, 54%, and 56% at 12, 24 and 36 months, respectively, but only 15%, 23%, and 26% at 12, 24, and 36 months, respectively, in the 138 children with normal electroencephalograms (P less than .001). A history of epilepsy in a first-degree relative was a significant risk factor only in idiopathic cases with abnormal electroencephalograms. In children with a remote symptomatic first seizure, either a history of prior febrile seizures or the occurrence of a partial seizure were significant predictors of recurrence. Age at first seizure and duration of seizure did not affect recurrence risk in either the idiopathic or remote symptomatic group. A total of 84% of the children were not treated with antiepileptic drugs or were treated for less than 2 weeks. Only 9% were treated for longer than 3 months. Treatment did not affect the risk of recurrence. The results suggest that, even without treatment, the majority of children with a first unprovoked seizure will not experiment a recurrence. Children with an idiopathic first seizure and a normal electroencephalogram have a particularly favorable prognosis.

Adolescent↗
PubMed1989

Electrocardiographic changes during electrographic seizures.

The occurrence of high-risk cardiac arrhythmias during electrographic seizures has been proposed as a possible cause for sudden unexpected death in patients with epilepsy. Several anecdotal case reports have documented various cardiac irregularities during seizures. We reviewed simultaneous 24-hour electroencephalographic - electrocardiographic studies obtained by ambulatory cassette electroencephalography in 45 patients who experienced 106 electrographic seizures. An increase in heart rate was seen in 96% of seizures, while in four seizures, the rate was unchanged. Heart rate increase measured from 1 minute preictally to intraictal peak ranged from 0% to 160% (mean, 60%). The onset of tachycardia was usually within several seconds (before or after) of the seizure onset, and often persisted for several minutes after termination of the discharge. No difference was found in patients with lateralized vs generalized seizures. Neither ventricular ectopia, conduction defects, or bradycardia were observed during the ictal episodes. We conclude that ictal tachycardia is the rule during electrographic seizures, and that high-risk cardiac arrhythmias are uncommon.

Adolescent↗
PubMed1989

The EEG response to diffuse and patterned photic stimulation during acute untreated alcohol withdrawal.

We studied the responses to diffuse and patterned stroboscopic light stimulation prospectively in 49 individuals during acute alcohol withdrawal prior to pharmacologic treatment. Photomyogenic responses (PMR) occurred in only two (4%) of those tested, and photoparoxysmal responses (PPR) never occurred. These findings suggest that PMR occur far less often during alcohol withdrawal than previously thought and that PPR may not be a direct manifestation of alcohol withdrawal.

Adult↗
PubMed1989

Psychologic and social adjustment to epilepsy in Rochester, Minnesota.

The psychologic and social aspects of epilepsy have rarely been assessed in community-based samples. We administered the Washington Psychosocial Seizure Inventory in 1985-1986 to 125 nonretarded adults, 18 to 59 years of age, who in 1980 had active epilepsy and resided in Rochester, Minnesota. Individuals having seizures or taking anticonvulsant medications within the past 12 months had somewhat poorer adjustment than those without recent seizures or medications, but even this more severely affected group appeared relatively well adjusted.

Adaptation, Psychological↗
PubMed1988

Alcohol consumption and withdrawal in new-onset seizures.

We studied alcohol use before the onset of a first seizure in 308 patients with seizures and 294 controls. The risk of seizures increased with increasing current alcohol use. For unprovoked seizures (i.e., seizures occurring without an antecedent event, such as a recent stroke), the adjusted odds ratios rose from 3-fold at intakes of 51 to 100 g of ethanol per day (95 percent confidence limits, 1.3 and 6.3), to 8-fold at 101 to 200 g per day (95 percent confidence limits, 3.3 and 18.7), and to almost 20-fold at 201 to 300 g per day (95 percent confidence limits, 6.1 and 6.2). For provoked seizures, the odds ratios were lower and statistically significant only above 200 g per day (odds ratio, 10.1; 95 percent confidence limits, 2.3 and 43.8 at 201 to 300 g per day; odds ratio, 7.4; 95 percent confidence limits, 1.8 and 30.5 above 300 g per day). Among ex-drinkers (abstention greater than or equal to 1 year), no increased risk was detected. Alcohol withdrawal was not associated with the onset of seizures in this study; 16 percent of first seizures in drinkers fell outside the conventionally defined withdrawal period, and the remainder exhibited a seemingly random timing after the last drink. We conclude that the relation of seizures to alcohol use is dose dependent and appears to be causal, and that seizures can be interpreted as a disorder induced by the ingestion of alcohol, independently of alcohol withdrawal.

Adult↗
PubMed1988

Complications of long-term anticoagulation.

We used life-table techniques to determine risks of morbidity and mortality associated with long-term warfarin treatment in an anticoagulation clinic. Cumulative risks for life-threatening complications and warfarin-related death among all patients were 1% at 6 months, 5% at 1 year, and 7% at 2 and 3 years. Cox regression analysis using age as a continuous variable failed to show an effect of age on cumulative risks of complication. The occurrence of a minor complication during the course of therapy did not place patients at higher risk for developing a major complication that would prompt discontinuation of therapy or cause death. There was no statistically significant difference between the cumulative risks of patients anticoagulated for cerebrovascular disease and the cumulative risks of patients anticoagulated for other indications.

Adult↗
PubMed1988

Voluntary health agencies as target populations for epidemiologic research.

The ability of two voluntary health agencies to provide suitable target populations for epidemiologic research was explored in a pilot study of epilepsy. The results suggest that, properly approached, voluntary agencies offer advantage for this purpose. In the first agency (Group A), subjects were recruited by mail, producing a response rate of 15%. In the second agency (Group B), subjects were recruited by telephone, producing a response rate of 87%. A structured, precoded telephone interview about personal and family history of seizure disorders was administered to both groups of subjects. Subjects in Group A gave permission to contact a higher proportion of their eligible relatives than did those in Group B (73 vs 57%). Permission was obtained more often for relatives reported to have had seizures (Group A 86%, Group B 78%) than for other relatives. 89% of relatives contacted directly agreed to be interviewed. Consent forms for medical record review were signed and returned by 95% of Group A and 77% of Group B subjects. Diagnoses of etiology and seizure type of epilepsy based on the interview data agreed with diagnosis based on the medical records in most cases. In first-degree relatives of subjects with epilepsy, reported rates of epilepsy did not appear to be seriously biased.

Adult↗
PubMed1988

Alcohol, seizures, and epilepsy.

Seizures, epilepsy, and alcohol are complexly interrelated. Although it is commonly perceived that patients with epilepsy experience problems with seizure control if they use alcohol, this is not confirmed by the few experimental studies that have tested the hypothesis. The last 30 years have emphasized the role of withdrawal from alcohol as a mechanism of seizure production. However, this is but one of many potential mechanisms by which seizures and epilepsy may be related to alcohol use and abuse. The rare but clear situations in which alcohol can act as a convulsant drug need further study, and mechanisms by which the long-term neurotoxic effects of alcohol lead to chronic epilepsy also need further elucidation.

Alcoholic Intoxication↗
PubMed1988

State-dependent changes in the N20 component of the median nerve somatosensory evoked potential.

Short-latency components of median nerve somatosensory evoked potentials are generally assumed to be unaffected by sleep and level of arousal. We found that sleep prolongs the latency and alters the morphology of the N20 component in normal subjects. These changes may represent differential effects of sleep on various elements contributing to generation of the N20. Failure to control for patient state may degrade the reliability of clinical somatosensory evoked potential testing.

Adult↗
PubMed1988

The risk of unprovoked seizures after encephalitis and meningitis.

A population-based cohort of 714 survivors of encephalitis or meningitis between 1935 and 1981 was followed in order to evaluate the risks of unprovoked seizures after CNS infections. The 20-year risk of developing unprovoked seizures was 6.8%, and the ratio of observed to expected cases of unprovoked seizures was 6.9. The increased incidence of unprovoked seizures was highest during the first 5 years after the CNS infection but remained elevated over the next 15 years of follow-up. The type of CNS infection and the presence or absence of seizures during the acute phase of the CNS infection greatly influenced the risks of subsequent unprovoked seizures. The 20-year risk of developing unprovoked seizures was 22% for patients with viral encephalitis and early seizures, 10% for patients with viral encephalitis without early seizures, 13% for patients with bacterial meningitis and early seizures, and 2.4% for patients with bacterial meningitis without early seizures. The 20-year risk of 2.1% for patients with aseptic meningitis was not increased over the general population incidence of unprovoked seizures.

Adolescent↗
PubMed1988

Higher risk of seizures in offspring of mothers than of fathers with epilepsy.

Seizure risk has consistently been found to be higher in offspring of mothers than of fathers with epilepsy. This pattern cannot be explained by any simple genetic model. The present study examined the possibility that the pattern arises from differences between affected mothers and fathers in the characteristics of their epilepsy that influence offspring seizure risk. The study population comprised 687 offspring of parents with epilepsy from the Rochester-Olmsted County Record Linkage Project. Cumulative incidences of unprovoked seizures to age 25 were 8.7% and 2.4% in offspring of affected mothers and fathers, respectively. Cox proportional hazards analysis was used to calculate rate ratios (RRs) for unprovoked seizures in offspring. In the univariate analysis, risk of unprovoked seizures was higher if the affected parent was the mother (RR = 2.8, 95% confidence interval [ci] 1.1-7.2) or if the parent's onset was before age 20 (RR = 2.5, 95% ci 1.1-5.9), but there was no effect on offspring risk of either parent's etiology (idiopathic vs. remote symptomatic) or parent's seizure type (generalized vs. partial). These findings were not substantially changed in the multivariate analysis. Thus, differences between affected mothers and fathers in these characteristics did not account for the higher risk in offspring of affected mothers. Anticonvulsant use during pregnancy was not associated with increased offspring seizure risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1987

Factors prognostic of unprovoked seizures after febrile convulsions.

We evaluated the risk of unprovoked seizures after febrile convulsions and the factors prognostic of them in a cohort of 687 children who had an initial febrile seizure while residing in Rochester, Minnesota. Overall, children with febrile convulsions had a fivefold excess of unprovoked seizures, and the risk until the age of 25 was 7 percent. The risk ranged from 2.4 percent among children with simple febrile convulsions to 6 to 8 percent among children with a single complex feature--i.e., focal or prolonged seizures or repeated episodes of febrile convulsions with the same illness. For children with any two of the complex features, the risk was 17 to 22 percent, and for those with all three features, 49 percent. The occurrence of subsequent partial unprovoked seizures was strongly associated with all three of the complex features, whereas the occurrence of subsequent unprovoked seizures of generalized onset was associated with the number of febrile convulsions and a family history of unprovoked seizures. These results are consistent with the view that the increased risk of generalized-onset unprovoked seizures reflects a predisposition to both simple febrile convulsions and generalized-onset unprovoked seizures. The association between complex febrile convulsions and partial seizures, on the other hand, may reflect either a causal association or the presence of preexisting brain disease that is responsible for both the complex febrile seizures and later partial seizures.

Adolescent↗
PubMed1987

Risk factors for complex partial seizures: a population-based case-control study.

This investigation is to our knowledge the first population-based case-control study of risk factors for complex partial seizures (CPS). Included in the study were all patients with onset of complex partial seizures before age 35, who were residents of Rochester, Minnesota, at the time of diagnosis between 1935 and 1979, and who were also born in Rochester (n = 82). Two control subjects were matched to each patient, and for both patients and control subjects, the unique records-linkage system for residents of Rochester was used to obtain information about possible risk factors. A history of epilepsy or febrile seizures in the mother, febrile seizures, neonatal convulsions, cerebral palsy, head trauma, and viral encephalitis were significantly more common in patients than in control subjects (p less than 0.05). None of the prenatal or perinatal factors investigated were found to be associated with complex partial seizures, except for being small for gestational age at birth. This factor lost significance after adjustment for cerebral palsy.

Cerebral Palsy↗
PubMed1987

ECG abnormalities in patients with epilepsy.

Some investigators believe that patients with epilepsy are at increased risk of sudden death, perhaps because of cardiac arrhythmias. We studied 338 patients with epilepsy referred for simultaneous ambulatory EEG/ECG monitoring. High-risk cardiac arrhythmias were detected in 18 (5.3%) patients while low-risk arrhythmias or negative studies were found in the others. Fifty-six electrographic seizures were seen in 17 patients, but no associated ventricular arrhythmias or conduction defects were identified. We conclude that the incidence of serious cardiac arrhythmias predisposing to sudden death is not increased in patients with epilepsy.

Arrhythmias, Cardiac↗
PubMed1987

Predictors of disease course in patients with probable Alzheimer's disease.

The presence of extrapyramidal signs or psychosis may indicate greater disability in patients with probable Alzheimer's disease. We evaluated the ability of these signs, noted at a patient's first visit, to predict one of two specific clinical endpoints: (1) a preselected score on the modified Mini-Mental State examination (cognitive endpoint), and (2) a preselected score on the Blessed Dementia Rating Scale (functional endpoint). Sixty-five patients were followed either until they reached the endpoints or to the end of the study period. Survivorship curves were drawn to predict the distribution of time to onset of an endpoint in patients with and without the clinical signs. Time to reach the cognitive endpoint was shorter for patients with extrapyramidal signs or psychosis compared with those without these signs and symptoms. These clinical signs did not predict the functional endpoint. We conclude that extrapyramidal signs and psychosis may be useful predictors of intellectual decline in Alzheimer's disease.

Activities of Daily Living↗