Biomedical subjects

D Hesdorffer

Publications and source records attributed to D Hesdorffer.

4 recordsLinked to original sources

PubMed2001

Treatment of nonfebrile status epilepticus in Rochester, Minn, from 1965 through 1984.

OBJECTIVE: To investigate the adequacy and efficacy of antiepileptic drug (AED) treatment of nonfebrile status epilepticus (SE). PATIENTS AND METHODS: We performed a population-based retrospective cohort study to evaluate the medical management of SE. Participants included 184 residents of Rochester, Minn, who experienced a first episode of nonfebrile SE between 1965 and 1984. RESULTS: Of the 184 patients, 133 (72.2%) received appropriate, prompt medical treatment for SE, i.e., intravenous diazepam, phenytoin, or phenobarbital. In 100 patients (75.8%), the dose of the first AED administered was less than that currently recommended. The first treatment was effective in terminating SE in 41 (31.1%) of 132 patients. The adequacy of treatment was highly predictive of drug efficacy (P = .002). The dose of the second AED treatment was inadequate in 52 (80%) of 65 patients treated. CONCLUSION: Based on this retrospective study, the treatment of SE is remarkable for both inadequacy and ineffectiveness. The inappropriate use of therapeutic regimens in the management of SE may be an important cause of ineffective medical treatment.

Adolescent↗

PubMed1998

Morbidity of nonfebrile status epilepticus in Rochester, Minnesota, 1965-1984.

PURPOSE: To analyze the nonfatal adverse events (AE) associated with a first episode of status epilepticus (SE). METHODS: We performed a population-based retrospective cohort study to determine the morbidity of SE. Participants included 184 residents of Rochester, Minnesota who experienced nonfebrile SE between 1965 and 1984. RESULTS: The etiology of SE was acute symptomatic in 100 patients and unprovoked in 84 patients. The most common seizure-types were continuous partial (n=56, 30%), generalized convulsive (n=52, 28%), and generalized with focal features (n=32, 17%). Morbidity related to SE was noted in 5 of the 146 patients (3.4%) surviving 30 days. The AE included hemiparesis (n=3), encephalopathy (n=2), mental retardation (n=1), and aphasia (n=1). All patients with morbidity had an acute symptomatic (n=4) or remote symptomatic (n=1) etiology. Thirty-four patients (18.5%) had a second episode of SE. CONCLUSIONS: Based on this retrospective study, significant morbidity related to SE is uncommon and is associated with the underlying etiology.

Acute Disease↗

PubMed1993

Reliability of seizure classification using a semistructured interview.

Methods for standardized classification of epileptic seizures are important for both clinical practice and epidemiologic research. In this study, we developed a strategy for standardized classification using a semistructured telephone interview and operational diagnostic criteria. We interviewed 1,957 adults with epilepsy ascertained from voluntary organizations. To confirm and expand the seizure history, we also interviewed a first-degree relative for 67% of subjects and obtained medical records for 59%. Three lay reviewers used all available information to classify seizures. To assess reliability, each reviewer classified a sample of subjects assigned to the others. In addition, an expert physician classified a sample of subjects assigned to two of the reviewers. Agreement was "moderate-substantial" for generalized-onset seizures, both for the comparisons between pairs of lay reviewers and for the neurologist versus lay reviewers. Agreement was "substantial-almost perfect" for partial-onset seizures, both for pairs of lay reviewers and for the neurologist versus lay reviewers. These results suggest that seizures can be reliably classified by lay reviewers, using operational criteria applied to symptoms ascertained in a semistructured telephone interview.

Adolescent↗

PubMed1990

Measurement and prediction of functional capacity in Alzheimer's disease.

Functional loss in Alzheimer's disease is difficult to measure or predict. The Blessed Dementia Rating Scale (Part 1) correlates well with postmortem changes but is not an effective antemortem index of functional change since disparate behavioral domains are assessed. We performed a factor analysis of the Blessed items in 187 patients with clinically diagnosed Alzheimer's disease and identified 4 independent factors: (I) cognitive, (II) personality, (III) apathy, and (IV) basic self-care. An endpoint, consisting of a score indicative of moderate disability, was determined for each factor. We then used life table analyses to compare the probability of reaching these endpoints over time in longitudinally followed patients. Patients with extrapyramidal signs at their initial visit reached the factor IV endpoint sooner, and those with psychosis or no family history of dementia also reached the factor I endpoint faster. These data illustrate the utility of a multifactorial approach to the assessment of functional capacity in Alzheimer's disease, and also indicate that extrapyramidal symptoms and psychosis are powerful predictors of the rate of decline in basic self-care activities and cognition.

Aged↗