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Biomedical subjects

D L Kraemer

Publications and source records attributed to D L Kraemer.

12 recordsLinked to original sources
PubMed1998

Temporal ictal electroencephalographic frequency correlates with hippocampal atrophy and sclerosis.

We studied 328 complex partial seizures (CPS) in 63 consecutive patients with temporal lobe epilepsy who underwent scalp electroencephalography/video monitoring, magnetic resonance imaging (MRI), and surgery. The initial ictal discharge (IID), defined as the first sustained electrical seizure pattern localized to the surgical site, was determined. If the IID was rhythmic waves, the median frequency was measured. To determine if IID frequency correlates with hippocampal atrophy (HA) or sclerosis (HS), hippocampal volume ratios (HVRs) were measured (n = 52) or assessed visually (n = 11) on MRI, and mesial temporal histopathology specimens (n = 22) were graded for HS. Sixteen patients (25%) had no or mild HA (HVR = 0.78-1.02), and 47 patients (75%) had moderate-to-marked unilateral (HVR = 0.33-0.76), or bilateral, HA. Theta frequency IIDs were significantly more commonly associated with moderate-to-marked HA than were delta IIDs. Theta frequency IIDs occurred in 19% of patients with mild or no HA, and 79% of patients with moderate-to-marked HA; delta IIDs occurred in 63% of patients with little to no HA, and 13% of those with moderate-to-marked HA. In addition, the median IID frequency inversely correlated with HVR and directly correlated with HS severity. In conclusion, faster frequency rhythmic IIDs during temporal lobe CPS correlate with greater degrees of ipsilateral HA on MRI, and higher grades of HS.

Adolescent↗
PubMed1998

Surgical outcome in patients with epilepsy with occult vascular malformations treated with lesionectomy.

PURPOSE: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure. METHODS: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection. RESULTS: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system. CONCLUSIONS: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.

Adult↗
PubMed1995

Neural network of structures in which GABAB receptors regulate absence seizures in the lethargic (lh/lh) mouse model.

In previous work we have shown that GABAB receptors are required for expression of absence seizures in the lethargic (lh/lh) mouse model; that lh/lh mice have increased numbers of GABAB binding sites compared to nonepileptic littermates (designated +/+); and that the magnitude of the increased number of GABAB receptors in lh/lh mice correlated positively with the frequency of absence seizures. We performed this study to delineate the neural network in which GABAB receptors regulate absence seizures in lh/lh mice. We designed three successive screens which had to be passed by a candidate neuronal population before it could be considered a member of the neural network in which GABAB receptors regulate absence seizures. First, the neuronal populations in lh/lh mice had to have enriched GABAB binding sites compared to homologous populations in matched nonepileptic controls; baclofen-displaceable 3H-GABA binding was measured in autoradiograms for this screen. Second, the candidate populations had to generate spike-wave discharges (SWDs) during absence seizures in lh/lh mice; bipolar recording electrodes implanted into candidate neuronal structures were used in this screen. Third, the candidate populations had to demonstrate GABAB receptor-mediated regulation of absence seizures in lh/lh mice; microinjections of a GABAB agonist [(-)-baclofen] and antagonist (CGP 35348) were used for this screen. In this study we found that anterior ventral lateral thalamic nucleus (VLa), nucleus reticularis thalami (NRT), nucleus reuniens (RE) passed all three screens, and hence are members of the neural network in which GABAB receptors regulate absence seizures in lh/lh mice.

Animals↗
PubMed1994

Vascular malformations and epilepsy: clinical considerations and basic mechanisms.

Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.

Brain Ischemia↗
PubMed1986

Cardiovascular responsivity to stress: family patterns and the effects of instructions.

Cardiovascular responses to two stressful tasks, as well as to instructions regarding the first task, were assessed in two generations of the same biological family (preadolescent children and their middle-aged parents). Information on the presence of hypertension and other cardiovascular disorders was also obtained for the grandparent generation. Results for the middle-aged normotensive adults confirmed previous observations among young adults of cardiovascular hyperresponsivity among offspring of hypertensive parents; hyperresponsivity was also observed during an instructions period prior to active participation in the task. Personality variables (Type A; hostility) were not related to the observed hyperresponsivity. Assessments of similarity of cardiovascular responses between preadolescent children and their parents were more equivocal; previous studies showing positive results have, for the most part, evaluated children who were somewhat older than those in the present study.

Adult↗
PubMed1986

Win some, lose some: parental hypertension and heart rate change in an incentive versus response cost paradigm.

Fowles (1983), citing evidence from separate studies, suggests that both incentive and response cost paradigms increase heart rate and should be subsumed under Gray's (1975) 'appetitive motivational system'. Shock avoidance and loss of reward (response cost) contingencies, while aversive, appear to evoke this motivational system; consequently both should elicit heart rate increases independent of anxiety. The present investigation compared magnitude of heart rate changes observed under conditions of winning and losing money. Results showed: no differences between incentive and response cost conditions; no effect of state anxiety on heart rate in these conditions, despite an elevation of state anxiety on the task day relative to a subsequent relaxation day assessment; and some evidence for the presence under both such appetitive conditions of cardiovascular hyperresponsivity among offspring of hypertensive parents. The results suggest a need for systematic parametric studies of experimental conditions.

Adult↗
PubMed1983

Progesterone withdrawal without parturition.

It has been demonstrated that administration of 100 mg of trilostane (an inhibitor of 3 beta-hydroxysteroid dehydrogenase) to late pregnant sheep will rapidly lower circulating levels of progesterone and that delivery ensues. Our intention was to reduce the dose of trilostane in order to separate the latter two sequelae and thereby obtain insight into the relationship between progesterone and prostaglandin biosynthesis. At the dose chosen (10 mg) the treatment did not induce parturition in 4 chronically catheterized sheep during late pregnancy. Circulating progesterone concentrations declined precipitously in all ewes but recovered to near basal values by 24 h after administration of trilostane. Circulating concentrations of 13,14-dihydro-15-keto-prostaglandin F2 alpha rose slightly but significantly at 4-5 h after administration of trilostane but never reached values normally associated with labor. Plasma estradiol levels were unchanged by treatment. These results are consistent with the view that progesterone withdrawal must be of a critical magnitude and duration for prostaglandin biosynthesis to be sufficiently stimulated to induce labor in sheep during late gestation.

Animals↗
PubMed1982

A sensitive radioimmunoassay for 11-deoxy-13, 14-dihydro-15-keto-11, 16-cyclo-prostaglandin E2: application as an index of prostaglandin E2 biosynthesis during human pregnancy and parturition.

A radioimmunoassay for 11-deoxy-13, 14-dihydro-15-keto-11, 16-cycloprostaglandin E2 (PGEM-II) is described. At pH 10.5, in the presence of albumin, 13, 14-dihydro-15-keto-prostaglandin E2 (PGEM-I) is transformed quantitatively into PGEM-II. Hence, after plasma samples are subjected to this transformation procedure, PGEM-II can be measured in such samples and be a true reflection of PGEM-I production and thereby prostaglandin E2 (PGE2) biosynthesis. The antiserum raised against PGEM-II is minimally cross-reactive with all prostaglandins tested (less than 0.01%). The mean least detectable mass of PGEM-II is 0.8 pg and the mean mass of added PGEM-II required to displace zero-point binding by 50% is 16.6 pg. The assay meets all the standard criteria for accuracy, reproducibility and parallelism. Concentrations of PGEM-II measured by this assay in peripheral plasma from men and nonpregnant women are similar to those reported for PGEM-I after measurements by gas chromatography - mass spectrometry. Plasma concentrations of PGEM-II in men were greater than in nonpregnant women. PGEM-II in increased concentration was found in early pregnancy although concentrations declined in the third trimester until labor when a significant increase was found. Concentrations of PGEM-II in umbilical venous plasma were significantly greater than those in maternal plasma.

Adult↗
PubMed1982

Pulsatile release of oxytocin during the estrous cycle, pregnancy and parturition in sheep.

Oxytocin has been measured in peripheral plasma from chronically catheterized sheep both during estrus and the early luteal phase of the estrous cycle and also during pregnancy at 122-124 days gestation, 141-145 days gestation and during spontaneous labor at term. In each experiment, blood samples were collected at 5-min intervals for 120 min and also at 1-min intervals for 10 min. In pregnant and nonpregnant sheep, pulsatile patterns of oxytocin concentrations were found in the experimental periods. Mean concentrations of oxytocin were significantly higher in plasma obtained during the luteal phase of the cycle when compared to samples taken during estrus. Moreover, concentrations of oxytocin were increased with length of gestation and labor. It is concluded that oxytocin secretion is episodic in sheep during both the estrous cycle and pregnancy.

Animals↗