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B Litt

Publications and source records attributed to B Litt.

12 recordsLinked to original sources
PubMed2004

Long-range temporal correlations in epileptogenic and non-epileptogenic human hippocampus.

Epileptogenic human hippocampus generates spontaneous energy fluctuations with a wide range of amplitude and temporal variation, which are often assumed to be entirely random. However, the temporal dynamics of these fluctuations are poorly understood, and the question of whether they exhibit persistent long-range temporal correlations (LRTC) remains unanswered. In this paper we use detrended fluctuation analysis (DFA) to show that the energy fluctuations in human hippocampus show LRTC with power-law scaling, and that these correlations differ between epileptogenic and non-epileptogenic hippocampus. The analysis shows that the energy fluctuations exhibit slower decay of the correlations in the epileptogenic hippocampus compared with the non-epileptogenic hippocampus. The DFA-derived scaling exponents demonstrate that there are LRTC of energy fluctuations in human hippocampus, and that the temporal persistence of energy fluctuations is characterized by a bias for large (small) energy fluctuations to be followed by large (small) energy fluctuations. Furthermore, we find that in the period of time leading up to seizures there is no change in the scaling exponents that characterize the LRTC of energy fluctuations. The fact that the LRTC of energy fluctuations do not change as seizures approach provides evidence that the local neuronal network dynamics do not change in the period before seizures, and that seizures in mesial temporal lobe epilepsy may be triggered by an influence that is external to the hippocampus. The presence of LRTC with power-law scaling does not imply a specific mechanism, but the finding that temporal correlations decay more slowly in epileptogenic hippocampus provides electrophysiologic evidence that the underlying neuronal dynamics are different within the epileptogenic hippocampus compared with contralateral hippocampus. We briefly discuss possible neurobiological mechanisms for LRTC of the energy fluctuations in hippocampus.

Electroencephalography↗
PubMed2001

Practice patterns of neurologists regarding bone and mineral effects of antiepileptic drug therapy.

BACKGROUND: Antiepileptic drug (AED) therapy has been linked to bone disease that can be treated and prevented with calcium and vitamin D. However, because there have been no definitive studies on this subject, many physicians might not be aware of this association. OBJECTIVE: To determine the approaches of neurologists to skeletal disorders in patients taking AEDs. DESIGN: A self-administered mail survey. PARTICIPANTS: United States board-certified or board-eligible pediatric (n = 404) and adult (n = 624) neurologists. MAIN OUTCOME MEASURES: Practice patterns of neurologists regarding methods of screening for bone disorders and recommendations for treatment and prophylaxis. RESULTS: Few pediatric (41%) and adult (28%) neurologists routinely evaluate AED-treated patients for bone and mineral disease. Of physicians who detect bone disease through diagnostic testing, 40% of pediatric and 37% of adult neurologists prescribe calcium or vitamin D, and about half (54% of pediatric and 57% of adult neurologists) refer patients to specialists. Few neurologists (9% of pediatric and 7% of adult neurologists) prescribe prophylactic calcium or vitamin D for patients taking AEDs. CONCLUSIONS: There is a lack of consensus among neurologists concerning the impact of AED therapy on bone. Because considerable evidence suggests that much of the bone pathology caused by AED therapy can be treated or prevented by administration of calcium and vitamin D, raising physician awareness of this problem could significantly improve the skeletal health of AED-treated individuals.

Adult↗
PubMed2001

Epileptic seizures may begin hours in advance of clinical onset: a report of five patients.

Mechanisms underlying seizure generation are traditionally thought to act over seconds to minutes before clinical seizure onset. We analyzed continuous 3- to 14-day intracranial EEG recordings from five patients with mesial temporal lobe epilepsy obtained during evaluation for epilepsy surgery. We found localized quantitative EEG changes identifying prolonged bursts of complex epileptiform discharges that became more prevalent 7 hr before seizures and highly localized subclinical seizure-like activity that became more frequent 2 hr prior to seizure onset. Accumulated energy increased in the 50 min before seizure onset, compared to baseline. These observations, from a small number of patients, suggest that epileptic seizures may begin as a cascade of electrophysiological events that evolve over hours and that quantitative measures of preseizure electrical activity could possibly be used to predict seizures far in advance of clinical onset.

Action Potentials↗
PubMed2000

Repetitive transcranial magnetic stimulation does not replicate the Wada test.

The authors compared inferior frontal speech arrest from repetitive transcranial magnetic stimulation (rTMS) with bilateral Wada tests in 17 epilepsy surgery candidates. Although rTMS lateralization correlated with the Wada test in most subjects, rTMS also favored the right hemisphere at a rate significantly greater than the Wada test. Postoperative language deficits were more consistent with Wada results. Available methods for inducing speech arrest with rTMS do not replicate the results of Wada tests.

Amobarbital↗
PubMed1998

Nonconvulsive status epilepticus in the critically ill elderly.

PURPOSE: To describe the electrographic and clinical features of nonconvulsive status epilepticus (NCSE) in the critically ill elderly and to identify potential predictors of outcome. METHODS: We prospectively identified 25 episodes of altered mentation and NCSE in 24 critically ill elderly patients associated with generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with anoxic encephalopathy were excluded. RESULTS: Of 25 hospitalizations, 13 (52%) resulted in death, and 12 (48%) patients survived to discharge. Death was associated with the number of acute, life-threatening medical problems on presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was associated with increased risk of death (p = 0.033). Ten patients with advance directives were managed outside the intensive care unit (ICU). Mean hospitalization was 39 days in the ICU group and 22 for those with advance directives (p = 0.017). CONCLUSIONS: Severity of illness correlates with mortality in critically ill elderly patients with NCSE. Treatment with intravenous benzodiazepines may increase their risk of death. Aggressive ICU management may prolong hospitalization at considerable cost, without improving outcome. It is unclear whether NCSE affects outcome in the critically ill elderly or is merely a marker for severity of disease in predisposed patients. The benefits of aggressive therapy are unclear. Carefully controlled, prospective trials will be necessary to determine the best therapies for NCSE in the critically ill elderly and the appropriate role of the ICU in their management.

Aged↗
PubMed1996

Race and sex differences in the distribution of cerebral atherosclerosis.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the influence of race, sex, and other risk factors on the location of atherosclerotic occlusive lesions in cerebral vessels. Previous angiographic studies of patients with stroke or transient ischemic attack (TIA) suggest that extracranial atherosclerosis is more common in whites and intracranial disease is more common in blacks. Noninvasive techniques such as duplex ultrasound, transcranial Doppler (TCD), and magnetic resonance angiography (MRA) allow vascular assessment of a more representative proportion of patients than does conventional angiography alone. METHODS: Consecutive patients evaluated at a community hospital for stroke or TIA over a 2-year period were reviewed. Lesions were defined as a 50% or greater atherosclerotic stenosis by angiography, duplex ultrasound, or TCD, or a moderate stenosis by MRA. RESULTS: Whites were more likely than blacks to have extracranial carotid artery lesions (33% versus 15%, P = .001), but the proportion of patients with intracranial lesions was similar (24% versus 22%). Men were more likely to have intracranial lesions than women (29% versus 14%, P = .03). When multivariate logistic regression analysis was used, white race was the only predictor for extracranial carotid artery lesions, and male sex was the only predictor for intracranial lesions. The cause of stroke/TIA was extracranial carotid artery disease in 8% and intracranial disease in 8% of all patients in the study. CONCLUSIONS: The distribution of cerebral atherosclerosis is influenced by race and sex but not by other vascular risk factors. In our patient population, intracranial disease is as common a cause of cerebral ischemia as extracranial carotid disease.

Aged↗
PubMed1994

Practical detection of epileptiform discharges (EDs) in the EEG using an artificial neural network: a comparison of raw and parameterized EEG data.

We have developed and tested "off-line" an artificial neural network (ANN) that successfully detects epileptiform discharges (EDs) when trained on EEG records marked by an electroencephalographer (EEGer). The system was trained on both parameterized and raw EEG data and can process 49 channels of EEG data in real time on an 80486/33 MHz personal computer, making it capable of processing EEG on-line in long-term monitoring units. Our detector consists of 2 stages: (1) a threshold detector identifies candidate EDs in 4-channel bipolar chains within the recording montage, parameterizes them and then passes these data to the second stage; (2) a 3-layer feed-forward ANN decides if a candidate wave form is an ED. The intersection of detector sensitivity and selectivity curves, or crossover threshold, for 10 patients from our Epilepsy Monitoring Unit occurred at 73% for parameterized EEG data and at 46% for "raw" EEG data. The ANN could be adapted to different EEGers' styles by changing the ANN output threshold for accepting candidate wave forms as EDs. In this "proof of principle" study the detector was trained on EEGs from 10 Johns Hopkins Hospital Epilepsy Monitoring Unit (JHH EMU) patients. We used different EEGs from the same patients for testing. Current testing should demonstrate that the ANN detector can generalize to previously "unseen" patients. This study shows that ANNs offer a practical solution for automated, real time ED detection that uses, standard, inexpensive computers, is easily adjustable to individual EEGer style and can produce sensitivities and selectivities similar to those of EEGers.

Brain↗
PubMed1993

Automatic EEG spike detection: what should the computer imitate?

We conducted a study to explore how electroencephalographers (EEGers) read EEGs and reach clinical impressions based upon them. Eight EEGers and a rule-based computerized "spike" detector marked epileptiform discharges ("EDs") in 12 test records. Of all marked events, 18% were marked by all readers and 38% were marked by only one reader. Readers agreed on basic clinical features of the records, such as whether a record demonstrated EDs, the rank order of ED sources by location, and the ranking of test records in order of the number of EDs detected. Readers marked records in a consistent pattern that was independent of an objective measure of expertise and experience. Our computerized ED detector had lower sensitivity and selectivity than human readers, but either parameter could be adjusted to be comparable to human EEGers at the expense of the other. We propose that EEGers employ reproducible, quantitatively different styles of reading EEG tracings to reach qualitatively similar clinical impressions. In practice, EDs are not absolutely defined, but appear to represent a continuum of activity which lends itself better to description and rank ordering than to absolute quantitation. More than just counting EDs, a successful computerized ED detector should be adaptable to the style of individual readers in order to help them efficiently formulate their clinical impressions.

Brain↗
PubMed1988

Practical limits on the biomagnetic inverse process determined from in vitro measurements in spherical conducting volumes.

A technique of locating current dipoles in spherical conducting volumes by determining the location of the magnetic field maximum and inverting the magnetic field equations was developed and the expected localisation errors were predicted. AC current dipoles were placed in spheres of uniform conductivity. Each dipole's magnetic field was measured and its location was calculated by determining the angle between the magnetic field null and maximum and using an iterative inverse solution to the magnetic field equations. Absolute agreement between predicted magnetic field strengths and actual magnetic field measurements was within 5%. A study of the effect of signal to noise ratio and number of data points in the analysis indicates that dipole localisation of approximately 1 mm is achievable for a signal to noise ratio greater than 10 decibels (S/N greater than 10 db).

Brain↗
PubMed1983

Influence of oral contraceptives on the incidence of premalignant and malignant lesions of the cervix.

The effect of oral contraceptive use on the development of severe dysplasia, carcinoma in situ and invasive carcinoma of the cervix was studied by a prospective longitudinal survey of 32,000 women. They were enrolled into the study between the ages of 15 and 39. Some had started oral contraceptive use before enrollment, others started after enrollment and some remained non-users throughout the study period. They were followed-up to 6-1/2 years. Analyses were performed on data from 24,784 women who met our criteria for incidence. Data were adjusted for years of follow-up, age at enrollment, age at first pregnancy, number of pregnancies, number of smears, and duration of use.

Adolescent↗