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Biomedical subjects

A Pilke

Publications and source records attributed to A Pilke.

12 recordsLinked to original sources
PubMed1995

Lateralization of event-related potentials during discontinuation of antiepileptic medication.

The effect of short-term withdrawal of antiepileptic drugs (AEDs) on auditory event-related potentials (ERPs) was studied in 16 patients undergoing preoperative evaluation for epilepsy surgery. ERPs were performed for all patients during treatment with full medication and after a 1-week period during ongoing tapering of AEDs. To clarify whether AED discontinuation would provide evidence of lateralizing for ERPs, we also studied the subgroup of 9 patients who had already undergone temporal lobectomies (TLE group). In the TLE group, if habitual seizures occurred < 30 h before the ERP recording session, auditory N1 and P3 amplitudes across sphenoidal electrodes were markedly decreased on the side ipsilateral to the epileptic focus. If seizures did not occur, asymmetries in amplitudes were equivocal and not of lateralizing value. In the whole group, midline N1 latencies for standard responses decreased significantly during AED discontinuation. At baseline, long-term habituation of the N1 component for standard responses was attenuated as compared with that of controls. During AED discontinuation, however, enhanced habituation of N1 was observed in TLE patients who did not exhibit seizures before ERP recording.

Adolescent↗
PubMed1995

Spectral EEG during short-term discontinuation of antiepileptic medication in partial epilepsy.

The effect of short-term discontinuation of antiepileptic drugs (AEDs) on spectral analysis of EEG background activity (spectral EEG) was studied in patients undergoing preoperative evaluation for epilepsy surgery. We also wished to clarify whether AED discontinuation would provide lateralizing evidence in spectral EEGs of patients with temporal lobe epilepsy (TLE). Spectral EEGs were performed in 15 patients receiving their regular medication regimen and again after a 1-week period during AED withdrawal. A subgroup of 9 patients who had previously undergone temporal lobectomies (TLE group) was studied separately. In this group, we evaluated the effect of preceding seizures on spectral EEG derived from temporal neocortical areas. In all patients, spectral EEG changes were detected even after a short-term AED withdrawal. The total amount of absolute delta activity was reduced and occipital peak frequency and relative alpha activity were increased as compared with baseline values. In TLE patients with habitual seizures occurring < 20 h before the spectral EEG recording, lateralization was correctly identified by the greater amount of absolute delta activity ipsilateral to the epileptogenic focus. Epileptic seizures are accompanied by subtle focal slowing in spectral EEG for a much longer period than has been assumed. In addition, postictal spectral EEG over the temporal lobes may have lateralizing value. Further studies in larger numbers of patients are needed to evaluate the role of spectral EEG in the preoperative evaluation of patients for temporal lobe surgery.

Adolescent↗
PubMed1995

Short-term withdrawal of antiepileptic medication: effects on attention and memory.

INTRODUCTION: The aim of this study was to determine the effect of routine withdrawal of antiepileptic drugs (AEDs) during preoperative evaluation on cognitive functions and also to clarify whether short-term withdrawal of AED would help to lateralize the epileptic focus and to highlight focal dysfunction of memory in patients with temporal lobe epilepsy. MATERIAL & METHODS: Cognitive function was evaluated in 25 patients on full medication and after 1-week during the ongoing AED withdrawal. Six additional patients without AED withdrawal were studied during the same time interval and served as controls. The effect of AED withdrawal on memory tests was evaluated in a subgroup of 11 patients with temporal lobe epilepsy (TLE group). RESULTS: In the TLE group, verbal recurrent-sequences learning tasks deteriorated significantly in patients with left-sided foci during AED withdrawal. In the whole group, attention, concentration and mental flexibility improved both in patients and in controls; the improvement was interpreted as being the result of the practice effect. During AED withdrawal, the number of errors in these tests decreased or remained unchanged. CONCLUSION: We suggest that preoperative neuropsychological testing can be scheduled at any time in patients referred for epilepsy surgery. In patients with temporal lobe epilepsy, the lateralizing results of selective memory tests may be most reliable if the testing is performed during AED withdrawal.

Adolescent↗
PubMed1995

Preoperative EEG predicts memory and selective cognitive functions after temporal lobe surgery.

Preoperative and postoperative cognitive and memory functions, psychiatric outcome, and EEGs were evaluated in 32 epileptic patients who underwent temporal lobe surgery. The presence and location of preoperative slow wave focus in routine EEG predicted memory functions of the non-resected side after surgery. Neuropsychological tests of the function of the frontal lobes also showed improvement. Moreover, psychiatric ratings showed that seizure free patients had significantly less affective symptoms postoperatively than those who were still exhibiting seizures. After temporal lobectomies, successful outcome in postoperative memory functions can be achieved in patients with unilateral slow wave activity in preoperative EEGs. This study suggests a new role for routine EEG in preoperative evaluation of patients with temporal lobe epilepsy.

Adolescent↗
PubMed1985

Computed tomography in a case of ophthalmoplegia syndrome.

Until now the radiological diagnosis of the Tolosa-Hunt syndrome has been made on orbital venography or arteriography. A case of Tolosa-Hunt syndrome, studied using computed tomography (CT), indicates that CT may be valuable in confirming the clinical diagnosis.

Dexamethasone↗
PubMed1984

Status epilepticus and alcohol abuse: an analysis of 82 status epilepticus admissions.

In 1979-80, 82 cases of grand mal status epilepticus (71 patients, 39 male and 32 female) were admitted to the Casualty Department of Meilahti University Hospital in Helsinki, Finland. The cause of the underlying epilepsy was symptomatic in 43 cases (52.4%) and idiopathic in 19 cases (23.2%). In 6 cases (7.3%), there was a history of alcohol withdrawal seizures, and in 14 cases (17.1%) there was no earlier history of convulsions. Status epilepticus was associated with an acute or progressive cerebral disorder in 14 episodes. These comprised 6 bouts of status with brain tumour, 4 with acute stroke and 4 with brain injury. Alcohol abuse preceded the status in 29 episodes (35.4%), 23 of which occurred in men (53.5% of the male cases). Excessive use of alcohol was the only obvious precipitating factor for status in 16 cases, and in 6 cases the status presented as a prolonged alcohol withdrawal seizure. A change or irregularity of anticonvulsive drug therapy could be documented in 14 cases and an acute infection outside the central nervous system in 7 cases. Intravenous diazepam, used as the only therapy for status epilepticus, was effective in 58 of 78 episodes. In 7 cases of prolonged status, a thiopental sodium anaesthesia proved effective. The total mortality was 4.2%, including 2 deaths from concomitant extracerebral disorders and one late death from brain metastasis.

Adolescent↗
PubMedDate not supplied

Prevention of alcohol withdrawal seizures with carbamazepine and valproic acid.

To evaluate the value of the nonsedative anticonvulsants carbamazepine and valproic acid a controlled study including drug monitoring was carried out. Intoxicated alcoholics (n = 138) were admitted for inpatient detoxication and randomly assigned to either carbamazepine (n = 43), sodium valproate (n = 46) or placebo (n = 49) in a double-blind fashion. Drug treatment lasted for four days and the daily doses of both drugs amounted to 1200 mg in the beginning of the study. Sodium valproate induced gastric distress, nausea and vomiting more frequently than placebo. About half of the subjects had to stop carbamazepine because of intolerable side-effects including vertigo, nausea, vomiting, diplopia and rash. Serum carbamazepine levels (18-89 mumol/l) were found to be high (greater than 40 mumol/l) in many but not all of these subjects. Seizures occurred in 3 subjects on placebo, 2 on carbamazepine and 1 on sodium valproate. Delirium tremens developed in 2 on sodium valproate and 1 on placebo. The study demonstrates that drug side-effects may seriously hamper the utility of carbamazepine and sodium valproate as routine treatment for the prevention of alcohol withdrawal symptoms.

Adult↗
PubMedDate not supplied

Postoperative EEG and electrocorticography: relation to clinical outcome in patients with temporal lobe surgery.

To evaluate the role of different EEG methods with respect to postoperative clinical follow-up, 32 non-lesionary epilepsy patients who had undergone temporal lobectomy were studied preoperatively and at 2-week, 3-month, and 1-year postoperative follow-up. Routine, sleep, and sphenoidal EEG recordings as well as intraoperative electrocorticography (ECoG) were made for all patients. At 1-year follow-up, the EEGs with sphenoidal electrodes and with sleep deprivation procedure provided important prognostic information; the appearance of seizures was associated with the presence of interictal epileptiform abnormalities in EEG. In the postresection ECoG, however, epileptiform abnormalities were not associated with clinical outcome or with postoperative epileptiform EEG at 1 year. Routine EEG reliably reflects clinical outcome after temporal lobectomy; with sphenoidal electrodes as well as with sleep deprivation procedure, the diagnostic yield can be further improved.

Adolescent↗