The effect of propofol on the electroencephalogram of patients with epilepsy

The effect of propofol on the electroencephalogram (EEG) in patients with epilepsy is still unclear. Case reports with electroencephalographic documentation highlight pro- and anticonvulsant effects and beta activation of the EEG. This prospective study sought to determine the effect of propofol in 17 patients undergoing cortical resection for intractable epilepsy. Each patient received 2 mg/kg of propofol intravenously and the EEG was recorded from chronically implanted subdural electrodes placed during a previous craniotomy. Frequency of interictal spikes, time to burst suppression, and appearance of beta activation were recorded. The median frequency of interictal spikes decreased significantly from 2 spikes/min before to 0 spikes/min after propofol (P = 0.001). Seizure activity did not increase after propofol. Profound burst suppression and an increase in beta activity were noted consistently. The use of propofol in patients with epilepsy seems to be safe but may interfere with the recording of EEG spikes.     

Language lateralization of Chinese-English bilingual patients with temporal lobe epilepsy: A functional MRI study.

Functional MRI was used to examine language lateralization of Chinese characters and English words associated with temporal lobe epilepsy (TLE) in Chinese-English bilinguals with left or right TLE. The results suggest that the neural basis of processing Chinese and English seems to be different, as normal controls demonstrated left hemispheric lateralization in reading English words but bi-hemispheric lateralization in reading Chinese characters. This difference in the neural bases of Chinese and English processing was found to affect the patterns in change-of-language processing associated with TLE. That is, whereas left-TLE patients were more likely than right-TLE patients to demonstrate a bi-hemispheric language involvement in reading English, both left- and right-TLE patients demonstrated primarily bilateral hemispheric involvement for reading Chinese characters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A four year study of therapeutical observation of patients with hypertension

We attempt to quantify compliance with hypotension medication regimens in 620 patients with hypertension at the Centros de Salud (community health centers) of Novelda and Elche (in the province of Alicante) and to assess the impact of a mixed-strategy health education program. The method used to evaluate compliance is the self-communicated interview as indicated by Haynes-Sackett. The intervention consisted of individualized instruction, family support, educational leaflets, and written instructions. Among the results obtained, we emphasize the following. First, 64% completed the treatment as prescribed, 16% stopped taking the medication, and 20% followed the regimen in a sporadic fashion, lack of motivation and forgetfulness being the main reasons cited for the latter. Second, 27% of the patients with hypertension--among them, primarily young people and men--do not visit the center for monitoring. Third, the health education program is responsible for a significant increase in blood pressure measurements and in therapeutic compliance, also reducing the number of drop-outs. Fourth, 26% did not come to the unit at the end of the study period (four years) despite phone calls and house visits as reminders.     

Technology fuels hope for patients with epilepsy

Technological advances are making surgery a viable option for people with medically intractable epilepsy. More temporal lobectomies are being performed on young adults, fueled by recognition that many consequences of growing up with epilepsy can be avoided with early surgery.     

The effects of psychological therapies under clinically representative conditions: A meta-analysis.

Recently, concern has arisen that meta-analyses overestimate the effects of psychological therapies and that those therapies may not work under clinically representative conditions. This meta-analysis of 90 studies found that therapies are effective over a range of clinical representativeness. The projected effects of an ideal study of clinically representative therapy are similar to effect sizes in past meta-analyses. Effects increase with larger dose and when outcome measures are specific to treatment. Some clinically representative studies used self-selected treatment clients who were more distressed than available controls, and these quasi-experiments underestimated therapy effects. This study illustrates the joint use of fixed and random effects models, use of pretest effect sizes to study selection bias in quasi-experiments, and use of regression analysis to project results to an ideal study in the spirit of response surface modeling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analysis of the WMS-III in patients with temporal lobe epilepsy.

Five competing models specifying the factor structure underlying the Wechsler Memory Scale--Third Edition (D. Wechsler, 1997b) primary subtest scores were evaluated in a sample of patients with intractable temporal lobe epilepsy (N=254). Models specifying separate immediate and delayed constructs resulted in inadmissible parameter estimates and model specification error. There were negligible goodness-of-fit differences between a 3-factor model of working memory, auditory memory, and visual memory and a nested--more parsimonious--2-factor model of working memory and general memory. The results suggest that specifying a separate visual memory factor provides little advantage for this sample--an unexpected finding in a population with lateralized dysfunction, for which one might have predicted separate auditory and visual memory dimensions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The inv dup(15) syndrome: a clinically recognizable syndrome with altered behavior, mental retardation, and epilepsy

The most common of the heterogeneous group of the extra structurally abnormal chromosomes (ESACs) is the inv dup(15), whose presence results in tetrasomy 15p and partial tetrasomy 15q. Inv dup(15), containing the Prader-Willi/Angelman syndrome (PWS/AS) region, are constantly associated with phenotypic abnormalities and mental retardation. We report on four additional patients with inv dup(15), whose behavioral pattern, and neurologic and physical findings further delineate the phenotype of this neurogenetic syndrome. We also provide FISH analyses on chromosomes of the observed ESACs and discuss the role of a number of genes located within the tetrasomic region.     

Auditory middle latency responses in patients with epilepsy

Middle latency auditory responses (MLRs) were studied in 55 normal subjects and 49 epileptic patients. We evaluated the function of the auditory system and of the temporal lobe in epileptic patients using MLRs. (1) The patients with epilepsy had significantly prolonged Pa and Nb latencies and the significantly increased amplitude of Pa-Nb component. (2) The prolongation and the increase of MLR components in latency and amplitude were more obvious in patients with intractable epilepsy than patients without intractable epilepsy. (3) The difference between left and right sides was larger in epileptic patients than normal subjects. (4) Epileptic patients with polypharmacy had reduced amplitude of Pa-Nb component and prolonged latency of Pa component than patients with monotherapy. Antiepileptic drugs (AEDs) appeared to decrease the amplitude of Pa-Nb component. It was supposed that the enhancement of amplitude of Pa-Nb component represented the abnormality of central nerve system in epileptic patients, in part.     

The Clarke Parent-Child Relations Questionnaire: A clinically useful test for adults.

Study 1 presents the standardization of the 16-scale Clarke Parent-Child Relations Questionnaire (PCR) for adults. 3 normal and 1 clinical abnormal samples comprising 508 18-55 yr olds were used. The scales sample, separately for mother and father, retrospective reports of aggressiveness, strictness, affection, indulgence, competence, and identification. There was little bias from IQ, social desirability, or education, and 14 of the 16 scales tended to be internally consistent. Factor analysis showed a moderate convergence among the scales as well as uniqueness. Two bipolar factors emerged, 1 for mother and 1 for father. The factors contrasted aggressiveness and strictness at one pole with affection, indulgence, and identification at the other. Study 2 compared 7 sexually deviant male groups of 247 Ss with 40 normal controls (all over age 18). Homosexual groups reported significantly more hostile relationships and low identification with father, whereas deviants who preferred immature partners reported aggression, strictness, and low affection in mother relationships. The test has been computerized. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group II phospholipase A2 in sera of febrile patients with microbiologically or clinically documented infections

Group II phospholipase A2 (PLA2-II) is an inflammatory enzyme, which has been shown to be an acute-phase protein and to correlate with the severity of sepsis. In a prospective study, the concentration of PLA2-II in the sera of 46 patients with sepsis and nonseptic bacterial and viral infections was measured by a fluoroimmunoassay. The serum concentration of PLA2-II in patients with infections (median, 164.5 micrograms/L; range, 5.07-1,740 micrograms/L) was elevated 46-fold above normal concentrations (median, 3.61 micrograms/L; range, 1.32-25.25 micrograms/L). The concentration of PLA2-II was higher in patients with sepsis (median, 284.5 micrograms/L; range, 12.95-1,574 micrograms/L) and nonseptic bacterial infections (median, 210.6 micrograms/L; range, 5.07-1,740 micrograms/L) than in those with viral infections (median, 46.78 micrograms/L; range 11.46-275.9 micrograms/L) (P = .0042). The concentration of PLA2-II correlated well with the concentration of C-reactive protein (CRP) (r = .613, P = .0001) but not with the concentration of pancreatic PLA2 (r = .089, P = .365). Measuring the serum concentration of PLA2-II is useful as an adjunct to the determination of CRP concentrations for differentiating bacterial from viral infection.     

A cognitively oriented psychologist looks at biofeedback.

Argues that emotional processes and their self-regulation are products of mediating cognitive appraisals about the significance of an event for a person's well-being and that the control of somatic processes is an integral aspect of emotional states and their self-regulation. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and behavioral interventions: A comparative evaluation with clinically distressed couples.

Compared the effects of communication skills training (CST) and cognitive therapy (CGT) in 32 severely distressed couples. Ss receiving CST showed significant improvement on main targets, the Communication Questionnaire, and a relationship beliefs inventory. CGT resulted also in significant improvements on these measures. On the direct behavioral observation measure, CST was superior to CGT. A direct comparison between both conditions indicated that CGT was more effective on the main targets, whereas CST was more effective on direct behavioral observation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A particular type of epilepsy in patients with congenital hemiparesis associated with polymicrogyria or unilateral pachygyria

INTRODUCTION: Magnetic resonance has permitted the recognition of cortical dysplasias in patients with congenital hemiparesia and epilepsy. OBJECTIVE: To study the clinic-EEG characteristics and course of epilepsy in patients with congenital hemiparesia and unilateral polymicrogyria. METHODS AND RESULTS: We analyzed the clinical histories of 11 patients seen between 1990 and 1996. We studied 6 girls and 5 boys aged between 5 and 13 years, with a follow-up period of from 1 to 6 years. The epilepsy began at between 1 and 6 years old with partial motor seizures. On EEG there were frontotemporal spikes in 9 cases, temporooccipital in 1 and parieto-occipital in another. All 11 patients had hemiparesia, with slight mental retardation in 9 patients and moderate mental retardation in 2. The CT/MR brain scan showed unilateral polymicrogyria. At between 2 and 8 years of age, all 11 patients developed subintrant atonic crises with a pseudo-ataxic gait, absences in 7 patients and myoclonia in 3. Awake EEG showed bilateral asymmetrical spikes. During sleep 7 patients had continuous spikewave discharges and 4 had frequent asymmetrical bilateral spikes. Four patients relapsed. Five patients are free of crises, five have sporadic crises and one continues to have daily crises. CONCLUSIONS: These patients had hemiparetic cerebral paralysis, slight mental retardation and epilepsy. At about the age of 6 a peculiar electro-clinical condition developed. Response to treatment was satisfactory, although the follow-up period is still not long.     

Surgical management of intractable epilepsy in patients with ganglioglioma

Long-standing intractable seizures are common manifestation of cerebral gangliogliomas. There is much controversy regarding the most appropriate surgical treatment (lesionectomy vs resection of the epileptogenic cortex with the lesion) for patients with intractable epilepsy associated with gangliogliomas. We reported 2 cases, in which the favorable seizure outcome was obtained following lesionectomy alone. (Case 1) Nine-year-old female developed attack of abnormal sensation in her left upper limb followed by motor seizure in her left limbs since 5 years old. MRI revealed hyperintense tumor in the right medial frontal lobe. Chronic invasive subdural recording showed that ictal onset zone was located in the hand motor area. Following lesionectomy alone, she became free from seizures. (Case 2) Eight-year-old girl had intractable generalized seizure since 6 years old. MRI revealed a cystic tumor in the right parietal lobe. She had multiple spike foci on electroencephalography and magnetoencephalography, and intraoperative electrocorticography failed to reveal the paroxysm. Following lesionectomy, she had good relief with less than one minor seizure per 1-3 months. Thus, lesionectomy, even without resection of the epileptogenic cortex, may improve seizure outcome in patients with ganglioglioma-associated epilepsy.     

The performance-complaint relationship in patients with epilepsy: a matter of daily demands?

In the currently envisioned mechanism of trypanosome mitochondrial RNA editing, U-insertion and U-deletion cycles begin with a common kind of gRNA-directed cleavage. However, natural, altered, and mutationally interconverted editing sites reveal that U-deletional cleavage is inefficient without and activated by ATP and ADP, while U-insertional cleavage shows completely reverse nucleotide effects. The adenosine nucleotides' effects appear to be allosteric and determined solely by sequences immediately adjacent to the anchor duplex. Both U-deletional and U-insertional cleavages are reasonably active at physiological mitochondrial ATP concentration. Notably, ATP and ADP markedly stimulate complete U-deletion and inhibit U-insertion reactions, reflecting their effects on cleavage. These plus previous results suggest that U deletion and U insertion are remarkably distinct.     

Salivary immunoglobulin concentrations in patients with epilepsy treated with carbamazepine

Various anti-epileptic drugs may affect the immune system. An IgA-depressing effect of carbamazepine has been proposed, but only serum concentrations have been studied. IgA constitutes a small fraction of the serum immunoglobulins, while it is the predominating one in external secretions. In the present study the concentrations of IgA, IgG and IgM in unstimulated saliva were determined by single radial immunodiffusion in 34 patients with partial epilepsy, and being treated with carbamazepine alone. Median salivary IgA concentration in the patients was 208 x 10(-3) g/l, compared to 150 x 10(3) g/l in 41 healthy controls. Salivary IgG and IgM concentrations were also somewhat higher in the patients than in the controls, while the albumin concentrations were similar in the two groups. However, the differences in the immunoglobulin concentrations between patients and controls were not significant at a 5% level. There was no significant correlation between the concentrations of IgA in saliva and serum.