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Biomedical subjects

W O Tatum

Publications and source records attributed to W O Tatum.

26 records · Page 2Linked to original sources
PubMed1995

Interictal single-photon emission computed tomography in partial epilepsy. Accuracy in localization and prediction of outcome.

The role of interictal brain single-photon emission computed tomography (SPECT) was examined using (99mTc)- labeled hexamethylpropyleneamine oxime (HMPAO) in refractory partial epilepsy. The accuracy with which SPECT localized an epileptic focus and whether it predicted long-term postoperative seizure relief were assessed. Twenty patients were evaluated, 14 of whom ultimately had anterior temporal lobectomy with follow-up ranging from 41 to 56 months. A single-headed gamma camera was used. The interictal SPECT showed ipsilateral temporal hypoperfusion in 8 (47%) of 17 patients with temporal lobe epilepsy and showed either multilobar hypoperfusion or no perfusion defects in the rest. The sensitivity and specificity were similar in patients with a more complex clinical picture who required intracranial electrodes and those who did not. Presence or absence of temporal lobe hypoperfusion did not correlate with postoperative seizure relief. It is concluded that interictal SPECT with 99mTc-HMPAO with a single-headed gamma camera does not add useful information in preoperative localization or predicting postoperative seizure relief.

Adolescent↗
PubMed1995

Gabapentin treatment of seizures in acute intermittent porphyria.

Most antiepileptic drugs (AEDs) available have demonstrated porphyrogenicity in hepatic porphyrias. Gabapentin is a new AED not appreciably metabolized by the liver in humans. We report two patients with acute intermittent porphyria successfully treated with gabapentin without its inducing porphyric crisis.

Acetates↗
PubMed1994

Technetium-99m-HMPAO SPECT in partial status epilepticus.

UNLABELLED: In this paper we correlate the findings on 99mTc-HMPAO brain SPECT with the results of clinical examinations and electroencephalography to determine the utility of SPECT in the evaluation of patients with suspected status epilepticus. METHODS: Thirteen patients with suspected status epilepticus underwent serial neurologic examinations, serial electroencephalograms, CT/MRI scanning and 99mTc-HMPAO SPECT. Seven patients were diagnosed with status epilepticus and six patients received other neurological diagnoses. RESULTS: All patients with status epilepticus at the time of the brain SPECT scan demonstrated focal hyperperfusion on SPECT in an area concordant with that suggested by EEG. One patient with status epilepticus demonstrated a persistent area of hyperperfusion on SPECT 24 hr after the cessation of status with no evidence of breakdown in the blood-brain barrier demonstrated by 99mTc-DTPA SPECT. No patient in this study without a diagnosis of status epilepticus had focal areas of hyperperfusion on SPECT. CONCLUSION: We suggest that a 99mTc-HMPAO SPECT scan demonstrating focal hyperperfusion in a patient being evaluated for partial status epilepticus is nonspecific. Even in the absence of a structural lesion causing local breakdown in the blood-brain barrier, it may indicate either ongoing status epilepticus or recently terminated status. However, a SPECT scan demonstrating no area of focal hyperperfusion argues against the diagnosis of partial status.

Adolescent↗
PubMed1991

Epileptic palatal myoclonus.

Palatal myoclonus (PM) is usually caused by lesions of the brainstem. We report a case of PM of focal cortical origin in a patient with epilepsia partialis continua. The PM sometimes occurred in isolation, and at other times was accompanied by unilateral face, neck, and arm twitching. This was documented by both EEG and SPECT.

Adolescent↗
PubMed1989

The open opercular sign: diagnosis and significance.

Four children with varying clinical manifestations, but with the unifying feature of severe developmental delay, had bilateral enlargement of the sylvian fissure confirmed by magnetic resonance imaging (MRI). Subsequently, we examined 125 consecutive MRI scans of the heads of pediatric patients, looking for this insular exposure, and did not find it. Pathological correlation in 1 child revealed arhinencephaly and abnormal gyral formation; another is known to have migrational abnormalities. We suggest that the open operculum is a sign of arrested development and is associated with other anomalies and a poor prognosis.

Cerebral Cortex↗
PubMedDate not supplied

New antiepileptic drugs: into the new millennium.

There has been an explosion of new antiepileptic drug availability for physicians to treat patients with recurrent seizures. Principal antiepileptic drugs consisted of 6 key agents for both generalized and partial epilepsy for nearly 8 decades. Since 1993, the availability of newer "second-generation" agents has nearly doubled the armamentarium available for the 2.5 million patients who have recurrent seizures. This new influx of medications has flooded the medical and lay community with choices never before appreciated. The promise of improved tolerability with different safety and efficacy profiles has been exciting for all involved in epilepsy management. While most of the newer agents have been approved for adjunctive use in medically refractory partial epilepsy with recurrent complex partial and secondarily generalized seizures, efficacy is expanding to include generalized epilepsy and children for some agents. Arch Fam Med. 2000;9:1135-1141

Anticonvulsants↗
PubMedDate not supplied

The neurosurgical treatment of epilepsy.

Despite the new advancements in antiepileptic drug development, thousands of people with epilepsy will remain intractable to medication. For a considerable proportion of these people, epilepsy surgery is a consideration for better control of their seizures. Resective surgery is now standard practice for patients with medication-refractory epilepsy. Temporal lobectomy continues to be the most common surgery performed. Once patients fail 2 to 3 optimal trials of antiepileptic medication, further drug therapy offers a minimal number of patients freedom from seizures. In contrast, temporal lobectomy in carefully selected patients may result in seizure-free outcomes in more than 70% to 90% of patients with intractable seizures. As technology and drug availability increases in the new millennium, it is important for the primary care physician to be aware of epilepsy surgery as a means to treat patients with antiepileptic drug-refractory epilepsy. Arch Fam Med. 2000;9:1142-1147

Brain↗