PubMed Health⌕ Search

Biomedical subjects

E Trinka

Publications and source records attributed to E Trinka.

At least 19 recordsLinked to original sources
PubMed2006

Transient and permanent magnetic resonance imaging abnormalities after complex partial status epilepticus.

Epileptic seizures, especially status epilepticus can produce MRI changes. In contrast to convulsive status epilepticus (CSE), permanent parenchymal loss is not well documented with nonconvulsive status epilepticus (NCSE) and the observed MRI changes are transient. We describe a patient with non-lesional right-sided temporal lobe epilepsy with complex partial seizures and repeated episodes of untreated complex partial status epilepticus (CPSE). Diffusion-weighted MRI exhibited marked and extended signal changes within the right temporal, frontal, insular and cingulate regions. The affected areas are considered propagation pathways of temporal lobe epilepsies. After admission, the patient was treated with i.v. antiepileptic drugs. Behavioral, EEG and MRI signal changes resolved. An atrophy of the right temporal lobe not seen in the pre-status MRI examinations was observed 6 weeks after the resolution of MRI hyperintensities. Prior episodes of CPSE had been correctly treated and remained without permanent brain damage. This case report is in favour of immediate and aggressive treatment of partial NCSE in order to avoid irreversible parenchymal loss.

Adult↗
PubMed2006

Subcortical deficit pattern after brain abscess: a neuropsychological study.

The consequences of brain abscess (BA) on cognition and behaviour have never been examined in detail. The aim of this study was to determine the long-term cognitive deficits of patients who suffered a BA and to estimate its effect on the quality of life. Twenty patients were included in the study. Follow up with neuropsychological and behavioural tests was performed 6 months to 42 years after BA (mean 10.4 +/- 11.9). Cognitive deficits were defined as a test score of 2 or more standard deviations below controls' mean in those tasks which revealed a significant group deficit. Compared with healthy age, sex and education-matched controls, 13 of 20 patients (65%) exhibited neuropsychological deficits in some cognitive tasks. Ten of those patients (50%) were significantly impaired in < or =2 cognition domains, whilst the remaining three patients (15%) showed three to five impaired domains. No correlation was found between neuropsychological impairments and patients' age, sex, initial neurological symptoms, size and localization of BA, or secondary epileptic seizures. Reduction in quality of life was found in five patients (25%). BA may cause long lasting cognitive deficits. Despite the focal character of the lesion, long-term sequelae follow a more diffuse subcortical deficit pattern.

Adult↗
PubMed2005

Gyratory seizures revisited: a video-EEG study.

PURPOSE: Gyratory seizures (GSs) have been rarely described in generalized as well as in focal epilepsies. They were defined as a rotation around the body axis during a seizure for at least 180 degrees. The mechanisms of generation are unknown and have been discussed controversially. The aim of this investigation was to further delineate seizure semiology and assess a possible lateralizing and localizing value of GSs. METHODS: The authors screened 277 consecutive patients with intractable epilepsies referred to a University Hospital for presurgical evaluation between 1998 and 2004 for GSs: 169 had temporal lobe epilepsy (TLE), 47 frontal lobe epilepsy (FLE), 38 generalized epilepsies (GE), and 23 had extratemporal or multifocal epilepsy. RESULTS: Twelve patients showed gyratory movements in 17 seizures. Eight had FLE and four TLE (p < 0.001). In 58% (7/12), the gyratory movement was initiated by a forced versive movement of the head followed by a rotation toward the contralateral side of seizure onset. In 42% (5/12), the gyratory movement was not preceded by a forced head version. In these seizures, the direction of the rotation was toward the side of seizure onset. CONCLUSIONS: The direction of rotation lateralizes seizure onset zone in focal epilepsy depending on the seizure evolution: 1) gyratory seizures (GSs) starting with a forced version of the head ensuing into a body rotation lateralize seizure onset zone contralateral to the direction of rotation. 2) In GSs without a preceding gyratory forced head version, the direction of rotation is toward the side of seizure onset. GSs occur more frequently in frontal lobe epilepsy than temporal lobe epilepsy, while none of our patients with GSs had generalized epilepsies.

Adult↗
PubMed2005

Transient global amnesia triggered by the intracarotid amobarbital procedure.

The emergence of a sudden, global, and fully reversible amnestic state during an intracarotid amobarbital procedure (IAP) performed in a patient with a right temporal tumor is described. Forms of amnesia during the IAP are discussed, and it is argued that because of its appearance, the associated behavioral abnormalities, and EEG findings, this state was a transient global amnesia (TGA). In addition to other origins such as bitemporal lesions, increased barbiturate levels, seizures, and epileptic amnesia, TGA may triggered by stress or angiography during the IAP.

Adult↗
PubMed2005

Cholinergic treatment of amnesia following basal forebrain lesion due to aneurysm rupture--an open-label pilot study.

Impairments of memory are often found after rupture and repair of aneurysms leading to a basal forebrain lesion. This open study investigated whether cholinergic substitution therapy may be a treatment option. The effect of donepezil, a cholinesterase inhibitor on memory functions was tested in an open-label, exploratory study in 11 patients with a chronic amnestic syndrome from a ruptured and repaired aneurysm of the anterior communicating artery (seven patients), the anterior cerebral (two) or the pericallosal artery (two). Mean time since onset was 75.4 months. Memory was evaluated at baseline and consecutively after 4 weeks of 5 mg donepezil daily, 8 weeks of 10 mg donepezil, and 4 weeks after drug discontinuation. Memory functions were assessed using the California Verbal Learning Test and compared with a matched group of normal, untreated controls. Tests of attention and of executive functions were also administered. Donepezil was well tolerated. Strong group effects were found at baseline and at all follow-up measurements showing profound impairments of memory functions in the patient group. Within patient statistics showed significant improvements of short and long delay free recall scores during the treatment period, both with 5 and 10 mg donepezil daily, whereas attentional and executive functions improved only non-significantly. Memory functions decreased after drug discontinuation. Repeated test administration in the control group also showed an increase of memory scores which was minor when compared with the performance change in the patient group. Donepezil may improve episodic memory functions in patients suffering from a chronic amnestic syndrome caused by rupture and repair of aneurysms of the anterior communicating, the anterior cerebral or the pericallosal artery. Future doubled-blind, placebo-controlled trials are warranted to confirm these findings.

Adult↗
PubMed2005

Absences in adult seizure disorders.

From a phenomenological point of view, absence seizures refer to any type of epileptic event characterized by loss of awareness and responsiveness. However, a phenomenological definition of absence seizures is hampered by difficulties in conceptualizing consciousness and needs to take into account the electroclinical features and anatomical basis of seizures. Sensu stricto, absence seizures are defined as an electroclinical pattern of generalized 3/s spike-wave activity accompanied by loss of awareness and responsiveness. Although there is general belief that absences are most often encountered in childhood or early adolescence, a considerable number of patients suffer from absences late into adulthood, which are often refractory to antiepileptic drugs. These patients generally fall into one of two groups. The first group consists of those who have more or less typical absences in childhood or adolescence which continue into adulthood, and may be accompanied by other generalized seizures or neurological impairment. Few data are available addressing whether the seizure semiology of the absences in these patients changes over time or not. The second class of patients corresponds to those in whom absences emerge for the first time in adulthood or even in the senium. These need to be carefully distinguished from later aggravation or semiological transformation of undiagnosed childhood epilepsies and from certain complex focal seizures originating from the frontal or temporal lobe. A wide range of aetiologically and anatomically diverse processes may lead to the appearance of epileptic absences. It is important to note that absences also vary in their intensity, their impact on the ability of the subject to respond and react, and in particular in their natural history and their response to antiepileptic medication.

Adolescent↗
PubMed2005

Interictal language functions in temporal lobe epilepsy.

OBJECTIVE: To evaluate interictal language functions in patients with medically intractable left and right sided mesial temporal lobe epilepsy (TLE). METHODS: Spontaneous speech, language comprehension, confrontation naming, repetition, reading, writing, and word fluency were examined in 12 patients with left sided TLE and 11 patients with right sided TLE. RESULTS: Four patients out of 23 displayed language deficits in more than one language domain. Three further patients exhibited isolated language deficits. Linguistic deficits were observed in both left TLE and right TLE. In quantitative analyses left and right TLE only differed in spontaneous speech (p = 0.02); no difference was found in other language functions, laterality quotient of Wada test, or overall IQ. Qualitative error analysis of object naming, however, showed typical errors associated only with left TLE. Patients with linguistic deficits were older at testing compared to patients without linguistic deficits (p = 0.003), whereas other factors including side of TLE, handedness, educational level, age at epilepsy onset, and duration of epilepsy did not differ between groups. CONCLUSIONS: Possible explanations for these findings include neuronal cell loss and deafferentiation in cortical areas, and disruption of the basal temporal language area pathways. Our study suggests that some patients with chronic mesial TLE exhibit linguistic deficits when specifically tested, and underlines the need to routinely investigate linguistic functions in TLE.

Adult↗
PubMed2004

Refractory status epilepticus due to acute hepatic porphyria in a pregnant woman: induced abortion as the sole therapeutic option?

A 22-years old, 55 kg female patient in the twelfth week of pregnancy developed neuropsychiatric syndromes and in the following status epilepticus. Raised porphyrines and porphyrine precursors were found in the patient's urine. Despite intravenous glucose infusions and appropriate medication no reduction in seizure-frequency and neuropsychiatric syndromes was observed. An abortion was induced. After the interruption and starting of haem arginate therapy, seizure activity stopped and porphyrine precursors returned to normal levels, and after 6 weeks the patient was discharged in excellent clinical condition. This report describes a status epilepticus caused by acute hepatic porphyria, triggered by pregnancy, in a 22-years old woman. To our knowledge this is the first report of induced abortion as successful treatment in acute hepatic porphyria induced status epilepticus.

Abortion, Induced↗
PubMed2004

Number processing in temporal lobe epilepsy.

BACKGROUND: Specific cognitive impairments have been found in association with mesial temporal lobe epilepsy (TLE), such as deficits in declarative memory or verbal abilities. No attention has been paid so far to possible deficits in number processing. OBJECTIVE: To investigate deficits in number processing in patients with TLE. METHODS: Numerical abilities were assessed in 28 right handed patients with medically intractable unilateral TLE and in a control group. RESULTS: No differences between patients and controls were found in analogue number processing with Arabic input, in a comparison task, or in simple addition and simple subtraction; however, there were significant group differences in tasks with verbal input, in simple division, in complex mental calculation, in a semantic knowledge task, and in conceptual tasks. Only minor differences were found between patients with right and left TLE. CONCLUSIONS: While numerical deficits may be expected in patients with left sided TLE, it is open for discussion why patients with right sided TLE also show numerical deficits.

Adult↗
PubMed2003

Peri-ictal water drinking lateralizes seizure onset to the nondominant temporal lobe.

The authors describe seven patients with medically refractory temporal lobe epilepsy whose seizures were associated with peri-ictal water drinking behavior. Presurgical evaluation, including video-EEG monitoring, MRI, SPECT, and neuropsychological testing, revealed a seizure onset in the nondominant temporal lobe. All patients had an excellent outcome after epilepsy surgery. Peri-ictal water drinking may represent a lateralizing sign indicating seizure onset in the nondominant temporal lobe.

Adolescent↗
PubMed2003

Epilepsy: comorbidity in the elderly.

Elderly people experience the highest incidence of epilepsy and their clinical mananagement is often challenging, due to a potential increase in the likelihood of adverse treatment events. In addition, concomitant diseases are highly prevalent in this population and elderly patients are likely to be prescribed a number of medications that must be taken concurrently. As a result, the incidence of adverse drug-drug interactions and adverse drug reactions is also extremely high. Thus, the treatment of elderly patients with epilepsy requires careful consideration of any comorbid conditions and concomitant medications. Most adverse events are drug-related and are therefore preventable. It is important to consider these complications when prescribing antiepileptic drug (AED) treatment. An AED with broad-spectrum efficacy, good tolerability and a favourable drug interaction profile (e.g. valproate, gabapentin and lamotrigine) may prevent many unwanted drug interactions and side effects.

Aged↗
PubMed2003

Linear scleroderma "en coup de sabre" coexisting with plaque-morphea: neuroradiological manifestation and response to corticosteroids.

A 24 year old woman in the 33rd week of pregnancy developed progressive neurological complications with right sided hemiparesis in association with the occurrence of linear scleroderma "en coup de sabre" (LSCS) and pre-existing plaque-morphea, already being treated by balneophototherapy. Further progression of neurological symptoms led to a caesarean section with the delivery of a healthy child. Brain magnetic resonance imaging (MRI) showed focal T2 signal increases in the left frontoparietal region directly adjacent to the area of LSCS. Cerebrospinal fluid analysis revealed oligoclonal bands, suggesting an intracerebral inflammatory process. Subsequent pulsed corticosteroid treatment led to a remission of neurological symptoms and to a marked resolution of the MRI lesions.

Adult↗
PubMed2002

Asymmetric termination of secondarily generalized tonic-clonic seizures in temporal lobe epilepsy.

In patients with secondarily generalized tonic-clonic seizures (sGTCS) an asymmetric termination of the clonic phase can be observed. The authors systematically analyzed this phenomenon in patients with temporal lobe epilepsy (TLE). Thirty-nine sGTCS from 29 patients with TLE who underwent successful epilepsy surgery were analyzed, in addition to a prospectively collected group of 28 patients with TLE who had 35 sGTCS. The clonic phase of sGTCS did not end synchronously in 65.7% of all patients and in 59.4% of all seizures. In 79.3% to 80% this was ipsilateral to the hemisphere of seizure onset, and there was excellent interobserver agreement.

Adult↗
PubMed2002

Abducens palsy after lumbar puncture.

OBJECTIVE: We report the case of a 43-year-old patient with neuralgic shoulder amyotrophy who developed abducens palsy on the left 4 days after diagnostic lumbar puncture (LP), which recovered completely within 4 months. RESULTS: Side effects after spinal tap are due to prolonged spinal fluid leakage and delayed closure of a dural defect causing intracranial hypotension. Downward 'sagging' of the brain and traction on cranial nerves may lead to abducens palsy. This case and a review of the literature illustrate the higher risk with the use of large-size traumatic needles in LP for cranial sixth nerve palsies. CONCLUSION: The presented case emphasizes the use of atraumatic small-size needles for lumbar puncture.

Abducens Nerve Diseases↗
PubMed2002

Hyperandrogenism, postprandial hyperinsulinism and the risk of PCOS in a cross sectional study of women with epilepsy treated with valproate.

Among a sample of 43 women with epilepsy treated for at least 2 years with valproate (n=22) or other antiepileptic drugs (AEDs) (n=21), polycystic ovary syndrome (PCOS) was diagnosed in three women, two of them were treated with valproate. Although the rate of PCOS and of menstrual disturbances, weight body mass index (BMI) and waist to hip ratio as well as fasting blood glucose levels, fasting insulin, proinsulin and C-peptide values was similar in this small sample of women treated with valproate and other AEDs, valproate exposure was associated with higher androgen levels, higher postprandial (pp) insulin and proinsulin levels, as well as lower cholesterol and low density lipoprotein (LDL) cholesterol levels. The pronounced increase in pp insulin levels during VPA treatment may indicate an effect of the fatty acid derivate VPA on pancreatic islet cells.

Adult↗