0000000000121632
AUTHOR
Günter Krämer
No evidence for efficacy of intrathecal verapamil in the treatment of tonic-clonic status epilepticus
In two patients with refractory generalized tonic-clonic status epilepticus, 15 mg of the calcium antagonist verapamil was given by suboccipital intrathecal administration. During a 2–6-h observation period, seizure frequency did not decrease. However, in one patient, verapamil induced severe hypotension. Subsequent thiopental anesthesia suppressed convulsions immediately. Our results indicate that, in contradistinction to animal studies with different administration techniques, intrathecal administration of verapamil does not produce any anticonvulsant effect in humans.
Clinical Syndromes, Pathogenesis, and Differential Diagnosis
The temporal sequence of signs and symptoms in patients with cerebral ischemia provides important information for the analysis of underlying pathophysiologic mechanisms and in the search for a major hemodynamic or embolic cause. The signs reported and symptoms assessed are useful for localization of the ischemic region of the brain and identification of the affected vascular territories. Even in the case of a typical clinical picture the clinical findings alone are often insufficient for unequivocal anatomic and pathologic identification, however important they may be in the choice of diagnostic and therapeutic measures. In the first few hours after cerebral ischemia, determining the progno…
Pathophysiology of Cerebral Ischemia
The weight of the brain amounts to only 2% of total body weight, but it receives 15% of the cardiac output and uses 20% of the oxygen consumed by the body. The energy supply is provided almost exclusively by glucose metabolism. The substrate for this is stored in the brain in the form of glucose or glycogen and is sufficient to cover the energy requirements for only about 1 min. Consequently, there is a delicate equilibrium between oxygen and nutrient supply from the blood and the energy requirements of the brain. Disturbances in neurologic function appear after a few seconds of ischemia, although they are not necessarily persistent at first.
Magnetic resonance imaging in infections of the brain: findings in tuberculosis, listeriosis, toxoplasmosis, subacute sclerosing panencephalitis, and multiple sclerosis.
A total of 6 patients with various inflammatory brain diseases were investigated by MRI. Typical diagnostic criteria like signal intensity, location, and morphology of the lesions are presented. MRI proves to be a highly sensitive method to detect encephalitic foci, which, however, suffers from a low specificity. Therefore additional informations like case history, clinical findings, and serological data have to be considered to find the correct diagnosis.
Cognitive-behavioral screening in elderly patients with new-onset epilepsy before treatment
Objectives Cognitive comorbidity at epilepsy onset reflects disease severity and provides a baseline estimate of reserve capacities with regard to the effects of epilepsy and its treatment. Given the high incidence of epilepsy at an older age, this study analyzed objective and subjective cognition as well as quality of life in elderly patients with new-onset focal epilepsy before initiation of anti-epileptic treatment. Materials and methods A total of 257 untreated patients (60–95 years of age) with new-onset epilepsy underwent objective assessment of executive function (EpiTrack) and performed subjective ratings of cognition (Portland Neurotoxicity Scale) and quality of life (QoL; QOLIE-31…
A randomized, double-blind comparison of antiepileptic drug treatment in the elderly with new-onset focal epilepsy.
Objective: To compare the effectiveness of controlled-released carbamazepine (CR-CBZ) to levetiracetam (LEV) and to lamotrigine (LTG) in elderly patients with newlydiagnosedfocalepilepsy.Methods: Randomized, double-blind, parallel-group trial conducted between January2007andAugust2011,in47ambulatoryorhospitalsitesinGermany,Austria,orSwit-zerland. Eligible participants were aged ≥60, had new-onset epilepsy, had no acute ill-nessasthecauseoftheirseizures,andhadnocontraindicationtothedrugsinthetrial.Patients were randomized 1:1:1 to CR-CBZ, LTG, or LEV. Doses were up-titrated for6 weeks and could be maintained or adjusted depending on seizure relapse or tolera-bility over an additional period …
Treatment and Prophylaxis
Following a stroke, the patient’s neurologic deficit may be most impressive, but his treatment and prognosis depend largely upon accompanying systemic disorders. Acute treatment, for instance, must take into consideration such things as cardiovascular disorders (myocardial infarction, valve defects, arrhythmias, hypertension), disorders of renal function, and diabetes mellitus. The early detection and treatment of such systemic problems can help to prevent complications that would be difficult to control later. Thus, in a patient with latent heart disease hypervolemic therapy with low molecular weight dextran may in fact elicit right heart failure and pulmonary edema instead of helping the …
Balance of T1-weighted images before and after application of a paramagnetic substance (Gd-DTPA)
Ten patients with encephalitis disseminata and 10 patients with cerebral ischemia underwent computed tomography and magnetic resonance imaging examinations. The results before and after the application of contrast media were compared. It is shown that T1-weighted MRI images, even after application of gadolinium-DTPA, are of little value for differential diagnosis of these diseases. In contrast, T2-weighted images did support the diagnosis of an acute stage of encephalitis disseminata versus acute ischemia. This was also true for lesions that had not been adequately depicted by computed tomography.
Internalized myofiber capillaries: Observations on their origin and clinical features
Internalized capillaries limited to type 1 muscle fibers were noted in seven patients. They occurred in each case in association with a similar admixture of neurogenic and myopathic features that included atrophic and hypertrophic fibers, internal nuclei, fiber splitting, and endomyseal and perimyseal fibrosis. Internalized capillaries in enlarged type 1 fibers arose from fiber splits on step section study of four patients. They occurred in the gastrocnemius, quadriceps, and soleus muscles from patients with a variety of disorders that included Becker dystrophy, diabetes mellitus and strenuous leg activities, Achilles tendon rupture, and myotonic dystrophy. Exercise-induced myalgias were no…
Combined therapy with acyclovir and adenosine arabinoside in herpes simplex encephalitis.
We report a case of herpes simplex encephalitis (HSE) with initial coma and severe left-sided hemiparesis in which combined treatment with adenine arabinoside and acyclovir was followed by complete recovery. This favorable result is discussed in view of the literature of HSE treatment including experimental studies on antiviral activity of both drugs. Combined treatment may be useful in severe cases of HSE.
Applied Anatomy of the Cerebral Arteries
Four arteries supply the brain with blood: the two carotid and the two vertebral arteries. Although these four vessels are ultimately interlinked via a basal arterial network, the circle of Willis, and anastomoses at the brain surface, Heubner’s anastomoses, it is useful to distinguish anterior (carotid anterior and middle cerebral) and posterior (vertebrobasilar posterior cerebral) vascular territories (Gillian 1957, 1968; Lazorthes 1961; Kaplan and Ford 1966; Ganshirt 1972; Seeger 1978; Dorndorf 1983; Duus 1983).
Epidemiology and Classification of Strokes
Epidemiology concerns the occurrence and distribution of diseases in the population. By prevalence is meant the number of cases of the disease at a particular moment in a given group of persons, for example, in the entire population of a certain territory or in a clearly demarcated population group. Incidence refers to the number of new cases of the disease occurring in a population in a particular period of time. Figures on prevalence and incidence are meaningful only if the given disease is unequivocally defined. If the definition is too specific, many cases are not included (false-negative cases), whereas too broad a definition leads to many false-positive identifications (Table 3.1). Di…
Internuclear ophthalmoplegia of abduction: clinical and electrophysiological data on the existence of an abduction paresis of prenuclear origin.
Three patients showed unilateral and five bilateral abduction paresis. Five had associated adduction nystagmus of the contralateral eye. Electrophysiological testing of masseter and blink reflexes indicated an ipsilateral rostral pontine or mesencephalic lesion, and excluded a lesion of the infranuclear portion of the abducens nerve. Abduction paresis was attributed to impaired inhibition of the tonic resting activity of the antagonistic medial rectus muscle. The prenuclear origin of the disorder is based on morphological and neurophysiological evidence of an ipsilateral inhibitory connection between the paramedian pontine reticular formation and the oculomotor nucleus running close to but …
The safety and efficacy of add-on levetiracetam in elderly patients with focal epilepsy: A one-year observational study
Abstract Purpose The long-term safety and efficacy of levetiracetam (LEV) was evaluated as add-on therapy in focal epilepsy patients ( n =491) aged at least 65 years who failed at least one monotherapy. Methods Patients ( n =491) with focal epilepsy treated with at least one antiepileptic drug in monotherapy with insufficient seizure control were included in this prospective open-label study. The recommended LEV dose range was 1000–3000mgperday. Follow-up visits were done approximately after 3, 6 and 12 months. Safety and efficacy was analysed based on all patients who received LEV (safety population, n =491) and all patients who were seen at all visits and completed the trial (per protocol…
Oxcarbazepine does not affect the anticoagulant activity of warfarin.
The possible interaction of the antiepileptic drug oxcarbazepine (OCBZ) on the anticoagulant effect of warfarin was investigated in 10 healthy male volunteers. After reaching steady-state conditions by repeated administration of warfarin, the prothrombin time (Quick value) was assessed before and after single (600 mg) and multiple dosing (450 mg twice daily in 1 week) of OCBZ. In 7 of the 10 volunteers with evaluable data, the prothrombin time was not significantly different (paired t test) from baseline either after single (p = 0.299) or repeated dosing (p = 0.333), indicating that OCBZ does not interact to any relevant extent with the hypothrombinemic effect of warfarin.