摘要:

Seizure‐inducing effects can be observed in the treatment of epileptic patients with antiepileptic drugs (AED). This may be a paradoxical reaction (for example the increase of complex focal seizures due to carbamazepine, vigabatrin or phenytoin treatment) or a result of AED‐induced encephalopathy (commonly induced by valproate in patients with complex focal seizures). A seizure increase during intoxication with AEDs is a rare phenomenon, thus, it is not directly related to this condition. An incorrect choice of drugs in the treatment of an epileptic syndrome or seizure type may provoke seizures (as for example the provocation of absences due to carbamazepine or phenytoin). The possible seizure‐inducing effect of AEDs has to be differentiated from seizure occurrence due to the natural course of epilepsy. This may be especially difficult in patients suffering from West syndrome or Lennox‐Gastaut syndrome, in whom seizure frequency may vary even without medication. However, especially in these patients, drug‐induced worsening of seizure manifestation is often observed. In general, a seizure‐inducing effect of antiepileptic drugs has to be considered when a seizure increase is observed soon after the initiation of therapy, when a stepwise increase of the dosage is followed by a further increase of seizures, a decrease of seizures is seen with tapering of the dosage and a renewed increase of seizures can be observed after this therapy has been reestablished. Finally, one knows that the clinical condition of encephalopathy due to valproate or carbamazepine is accompanied by seizure increase. In spite of these clinical aspects, the underlying mechanisms of seizure increase mostly remain unclear. From animal experiments it is obvious that especially carbamazepine and phenytoin may provoke generalized seizures as absences or myoclonic seizures. A seizure increase during vigabatrin therapy has been attributed to the increase of the cerebral amount of gamma‐amino‐butyric acid, which is known to possibly exhibit inhibitory or excitatory neuronal effects. The occurrence of tonic seizures in patients with Lennox‐Gastaut syndrome has been attributed to the sedative effect of the drugs; however, this conclusion is controversial. From a clinical point of view, one should consider young age of the patient, mental retardation, antiepileptic polytherapy, high frequency of seizures or prominent epileptic activity in the electroencephalogram previous to medication as risk factors for a possible seizure‐inducing effect of

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00047.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objectives– To determine cerebral atrophy parameters on MRI images of epileptic patients.Material and methods– Examination of the brain was performed in a 0.5 Tesla magnet in 32 women with epilepsy and 36 female healthy controls. Fifteen patients were classified to have generalised epilepsy and 17 had partial seizure onset. Epileptic patients with structural brain changes were excluded. At midsagittal level the area of corpus callosum, cerebrum and cerebellum were selected as atrophy parameters. At transverse level the ventricle‐brain ratio (VBR) as a measure of overall cerebral atrophy, bifrontal ratio (BFR) reflecting atrophy in the area of the frontal horns, bicaudate ratio (BCR) and bioccipital ratio (BOR) were calculated to evaluate atrophy in the region of nucleus caudatus as well as in the occipital area.Results– The mean values of VBR were significantly larger in the two epileptic groups than in controls, p = 0.0003. No significant difference in mean VBR were found between focal and generalised seizure onset epilepsy. Also significant decreased cerebellar area on midsagittal section was detected in epileptic patients with partial onset epilepsy compared with controls, p = 0.037. Atrophy was not associated with type and duration of epilepsy, but VBR and age were positively associated in patients with generalised onset seizures.Conclusion– These findings suggest general brain atrophy to be present in epileptic patients including those with partial epilepsy. Whether atrophy in epileptic patients occurs as a consequence of disease‐related factors like hypoxia or treatment with antiepileptic drugs has to be investigated in a prospectively des

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00048.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

We report a patient who presented with a whole body microsomatoagnosia as part of an epileptic aura. We postulate that this rare phenomenon argues in favor of the existence of a whole body integrative neuronal network which mediates the bodily awareness.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00049.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Environmental influences operating as possible risk factors in MS were studied in Moscow. The study included 155 MS patients from the Neurology Departments and the outpatient clinics of the First City Hospital of Moscow and 155 controls matched for sex, age in 5‐year intervals, nationality, and origin (Moscow vs. non Moscow). 72.3% of controls were recruited among patients from the same hospital as the cases. The remaining controls were volunteers from the hospital staff or medical students. Exposures before age 15 were of special interest. MS patients reported a higher frequency of: 1) tonsillitis; 2) allergic reactions after age 15; 3) head trauma below age 16; 4) a predominant meat vs. vegetable diet during childhood. Stratified analysis and logistic regression pointed to “meat predominance” as the most significant risk factor. Other associations were confounded by the respondents' occupation/educ

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00050.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

This case‐control study was aimed at identifying environmental risk factors for multiple sclerosis (MS). Ninety‐three Israeli‐born MS patients identified in country‐wide studies and 94 age‐ and sex‐matched controls were interviewed. The questionnaire covered a large span of factors at ages 0,10 and onset of the disease, with particular emphasis on socioeconomic status (SES) and sanitary conditions (SAN). A significantly larger percentage of patients reported frequent respiratory diseases. Patients and their parents had significantly (p<0.01) higher educational levels than controls. The SES and SAN at age 10 were also systematically higher among patients, but significance was reached only when the frequencies of conditions indicating extremely low values of SES or SAN were compared. It is possible that the protective effect of low SES and SAN on risk of MS can be detected only when living conditions are well below average, as is frequent in developin

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00051.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Introduction‐ In about 20% of MS patients an increased CSF/serum albumin quotient (QAlb) has been observed. The reason for this blood‐CSF barrier dysfunction is yet unclear.Subjects and methods‐ QAlbvalues from 48 MS patients in relapse were correlated with parameters of active CNS lesions as measured by gadolinium‐DTPA MRIs. QAlbvalues from 20 MS patients without relapse served as controls.Results‐ Mean QAlbvalues (×103) of a group with spinal cord lesions (7.6±3.6; n=16) differed significantly from those of a control group (4.6±1.5; n=20; p<0.005) as well as from those of a group with supratentorial lesions (5.0±1.8; n=18; p<0.05), and were higher than those of a group with infratentorial lesions (5.8±2.8; n=14). QAlbvalues of patients with a spinal lesion tended to decrease with increasing time intervals between onset of relapse and lumbar puncture.Conclusions‐ The data is in consent with the present knowledge on flow dynamics of both extracellular fluid and CSF. As a clinical consequence, increased QAlbvalues in MS patients may hint at an active spinal or, less likely, infra

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00052.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

It has been suggested that nitric oxide could be implicated in the pathogenesis of Alzheimer's disease (AD). Recently Kuiper et al. reported decreased CSF nitrate levels (oxidation product that provides an indirect estimation of nitric oxide) in AD patients, assessed with a colorimetric method. However other group, using a microplate version of the Griess reaction, did not confirm these findings. We studied the CSF and plasma levels of nitrate with a kinetic cadmium‐reduction method in 32 AD patients and 36 matched controls. The CSF and plasma nitrate levels did not differ significantly between the two study groups. CSF and plasma nitrate levels did not correlate with age at onset and duration in the patient group. These data suggest that CSF and plasma levels of nitrate are apparently unrelated with the risk for A

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00053.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Objective– Association of leuko‐araiosis (LA) with certain risk factors has been reported in Western patients. This is a case‐control study to determine the risk factors and the type of stroke associated with LA in Saudi patients.Design and setting‐ 398 consecutive Saudi patients with the diagnosis of stroke admitted over a 6‐year period were evaluated for presence or absence of LA on cranial computed tomography. LA and non‐LA groups were compared with regards to the presence of certain risk factors such as type of stroke, age, brain atrophy, systemic hypertension and history of cardiac disease or diabetes mellitus. The odds ratio and its 95% confidence interval (CI) were used to estimate the strength of association between the different parameters.Results– The mean age in the LA group was 67.8±8.5 years as compared to 61.2±13.2 years in the non‐LA group. No patient younger than 40 years had LA on CT. Incidence of LA increased with age. Forty‐seven percent of the LA group were over 70 years of age compared to 31 % of the non‐LA group (OR=2, CI 1.26–3.15). Generalized atrophy was detected in 40% of patients with LA compared to 20% of non‐LA group (OR 2.7, CI 1.65–4.39). Sixty‐nine percent of patients in the LA group had lacunar infarct compare to 39% in the non‐LA group (OR 3.4, CI 2.15–5.59). The difference was not significant between the two groups in relation to the frequency of cerebral hemorrhage or larger infarcts. Systemic hypertension was also significantly associated with the presence of LA (OR 2.15, CI 1.34–3.43).Conclusion– LA is associated mainly with lacunar infarcts, cerebral atrophy, systemic hypertensi

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00054.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00055.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1996.tb00057.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY