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F Kerling

Publications and source records attributed to F Kerling.

14 recordsLinked to original sources
PubMed2006

Identifying the affected hemisphere by (1)H-MR spectroscopy in patients with temporal lobe epilepsy and no pathological findings in high resolution MRI.

Up to 30% of patients with temporal lobe epilepsy (TLE) remain without remarkable changes in MRI. In this study we investigated the role of (1)H-MR spectroscopy ((1)H-MRS) in lateralizing the affected hemisphere in the mentioned patient group. Twenty-two consecutive patients diagnosed with TLE were investigated by high resolution MRI and (1)H-MRS. We examined the incidence and diagnostic accuracy of temporal metabolite alterations determined by Linear Combination of Model Spectra (L C Model) via water reference. Metabolite values of each hemisphere of TLE patients were compared with healthy controls. Results of metabolite alterations were related to intensive video EEG focus localization. Reduction of N-acetylaspartate + N-acetylaspartyl-glutamate (tNAA) in the affected hemisphere revealed identification in six of nine patients (66%) with unilateral TLE. Group comparison revealed a significant reduction of tNAA (6.1+/-0.8*) in the involved temporal lobe compared with controls (6.67+/-0.4*, P=0.026). Choline levels were significantly increased in the affected hemisphere (1.42+/-0.17*) compared with healthy controls (1.22+/-0.17*, P=0.035). The results of our study show that (1)H-MRS is able to identify the affected hemisphere of MRI negative TLE patients and can be used as an additive tool in multimodal focus localization.

Adult↗
PubMed2006

Influence of levetiracetame on ictal and postictal EEG in patients with partial seizures.

To investigate the influence of levetiracetame (LEV) treatment on the interhemispheric seizure pattern propagation and postictal recovery of electroencephalography (EEG) background activity. Twenty-three adult patients (age > 16 years) with pharmacoresistant focal epilepsies presenting at the Epilepsy Center Erlangen for pre-surgical evaluation were enrolled in the study. Those eligible patients receiving only one antiepileptic drugs were recruited to the 48-h baseline phase and, after at least two seizures, were randomized to the 7-day treatment phase with either LEV (n = 11) or placebo (n = 12). All participants were submitted to continuous day-and-night video-EEG monitoring. The daily dose of LEV was 1000 mg (500 mg bid.) on the first treatment day and was increased to 2000 mg (1000 mg bid.) from the second day onward. The EEG changes relating to the time delay of the interhemispheric seizure pattern propagation and to the postictal recovery of the background activity were analysed by computerized video-EEG recording and compared using the non-parameter Mann-Whitney U-exact test (alpha = 0.05). A prolonged latency of the contralateral seizure pattern propagation was observed in the LEV group, whereas a more rapid propagation was observed in the placebo group (P = 0.009). Postictal generalized slowing of the background activity was recorded in 21 patients during the baseline phase. More rapid postictal recovery of the EEG background activity was observed in the LEV, but not in the placebo group (P = 0.03). This study demonstrated that LEV not only prevented the seizure pattern propagation but also helped the speedy recovery of the postictal background activity in the EEG.

Adult↗
PubMed2004

[Supratentorial cavernoma and epileptic seizures. Are there predictors for postoperative seizure control?].

For cavernous haemangiomas, it is the aim of surgical treatment to control epilepsy and eliminate potential sources of intracerebral haematomas. In the following investigation, it was attempted to find indicators for seizure freedom after surgery. Success of therapy was assessed according to three patterns of classification. Thirty patients underwent tailored resection based on findings from preoperative investigations and intraoperative electrocorticography. Follow-up averaged 4 years. Lesionectomy, extended lesionectomy, and modified lobe resection were carried out in 13, 11, and six patients, respectively. For all procedures, including microsurgical lesionectomy, the firm gliotic layer unequivocally differed in colour and consistency from normal brain and was removed. Further tissue resection was carried out only if the electrocortical course suggested persistent spike activity around the resection cavity or if presurgical MRI evaluation (e.g. hippocampal atrophy) or electrophysiology also pointed to pathology distant from the lesion. Of the patients, 53.3% became completely seizure-free (Engel I), and one additional patient had only occasional isolated auras. Dramatic reductions in seizure frequency and severity were exhibited by 26.7%. Outcome in respect to seizure control was not associated with resection procedure, comparing pure lesionectomy with lesionectomy plus cortectomy. In the group of patients with epilepsy surgery, those with hippocampectomy had significantly better outcome than those without. Important prognostic factors were early operation after seizure manifestation (91.7% operated upon within 2 years of seizure onset became seizure-free). Another prognostic factor was unifocal seizure onset (bilateral or multifocal seizure onset was found in care of the ten patients with unfavourable outcome). None of the four patients harbouring multiple cavernomas became seizure-free after resection of one lesion, which was believed to be mostly attributable to the epileptic focus that was removed.

Adult↗
PubMed2002

Fractionated stereotactically guided radiotherapy of pharmacoresistant temporal lobe epilepsy.

PURPOSE: This prospective study evaluated the efficacy of fractionated stereotactically guided radiotherapy (SRT) as a treatment of pharmacoresistant temporal lobe epilepsy. PATIENTS AND METHODS: Inclusion criteria were patients aged between 17 and 65 years with unilateral temporal focus, without sufficient epilepsy control by antiepileptic drugs or neurosurgery. Two groups of 6 patients each were treated with 21 Gy (7 times 3 Gy) and 30 Gy (15 times 2 Gy). Study end points were change in seizure frequency, intensity, seizure length and neuropsychological parameters. RESULTS: All patients experienced a marked reduction in seizure frequency. The mean reduction of seizures was 37% (range 9-77%, i.e. seizures reduced from a monthly mean number of 11.75 to 7.52) at 18 months following radiation treatment and 46% (23-94%, i.e. 0.2-23 seizures per month) during the whole follow-up time. Seizure length was reduced in 5 out of 11 patients and intensity of seizures in 7 out of 11 patients. CONCLUSION: Radiotherapy was identified as a safe and effective treatment for pharmacoresistant epilepsy since a good reduction of seizure frequency during longer follow-up was observed. SRT means an appropriate alternative for patients with contraindication against neurosurgery or insufficient seizure reduction after neurosurgery.

Adolescent↗
PubMed2002

[Goose flesh and cold sensation. Symptoms of visceral epilepsy].

Goose flesh and cold shiver can be ictal signs of visceral epilepsies. These visceral epilepsies may occur with isolated ictal signs during a simple partial seizure or in combination with other autonomic signs or in complex partial seizures. Because of the unusual features of the ictal symptomatology, these visceral epilepsies often are masked and wrongly diagnosed as nonepileptic events, e.g., somatoform disorders. Five cases are reported with case history, neurological findings, and results of electroencephalography, MEG, and imaging. Interestingly, patients did not suffer from tumoral epilepsies and the epileptic focus was lateralized to the left (dominant) temporal lobe.

Adolescent↗
PubMed2002

Autonomic auras: left hemispheric predominance of epileptic generators of cold shivers and goose bumps?

PURPOSE: Autonomic seizures in temporal lobe epilepsies associated with "cold shivers and goose bumps" as a principal ictal sign or aura have only rarely been studied. METHODS: Sixteen patients with autonomic auras [cold shivers or cold sweats (n=11), goose bumps (n=4), one patient showed both ictal signs] were analyzed. RESULTS: Lesions were detected in 12 patients. The etiology was heterogeneous [cryptogenic, arteriovenous (AV)-malformation cyst, trauma, hippocampal sclerosis]. Eight patients underwent epilepsy surgery. The localization and lateralization of the focal epileptic activity in the temporal lobes was determined either by magnetic resonance imaging lesions, EEG, ictal signs, or single-photon emission computed tomography imaging. CONCLUSIONS: The patients with temporal lobe epilepsies associated with "cold shivers and/or goose bumps" showed a left hemispheric predominance of the focal abnormality in the temporal lobe.

Adult↗
PubMed2001

[Diagnostic imaging in refractory temporal lobe epilepsy. A comparison of MR volumetry and multivoxel-MR-spectroscopy for assessment of postoperative prognosis].

While the importance of magnetic resonance (MR) spectroscopy, volumetry, and T2-relaxometry for preoperative localization has already been verified, the question arises as to what extent the individual techniques are useful for assessing postoperative prognosis with respect to seizures and neuropsychological outcome. In a prospective comparative study, 26 patients were examined preoperatively with a 1.5 T whole-body scanner. The MR spectroscopy was taken by high resolution 1 H proton spectroscopy, the volumetry with MP rage technique. The postoperative outcome was laid down using Engel's classification. Our results show that the metabolic changes can be divided into three groups using MR spectroscopy: unilateral, slightly bilateral, and severely bilateral to contralateral. In case of bilateral changes, the severity of metabolic changes in the nonoperated, contralateral side was decisive for postoperative outcome. The results from volumetry did not correlate with postoperative outcome.

Adult↗
PubMed2001

Therapeutic intensive seizure analysis (TISA) in presurgical evaluation of Losigamone.

OBJECTIVE: The new method TISA was used to evaluate Losigamone efficacy. METHODS: Sixteen patients with pharmacoresistant partial seizures undergoing presurgical evaluation were randomized in this double-blind, placebo-controlled, parallel-group Losigamone monotherapy study under continuous video-EEG monitoring. Duration (in s, of each seizure and each ictal sign), intensity (grade zero to three), N/24h (number of seizures and ictal signs per 24 h), D/24h (seconds per 24 h covered by seizures and ictal signs) and seizure free intervals were recorded. RESULTS: A total of 246 seizures were intensively analyzed. The duration and intensity of all seizures improved more in the active treatment group than in the placebo group. There was a statistically significant superiority in the duration of the seizure free interval in the Losigamone group. Ictal signs such as oro-alimentary automatisms and fumbling were improved during Losigamone treatment. CONCLUSION: Losigamone has a preferred inhibitory effect on propagated epileptic activity. TISA is a sensitive method for evaluation of the selective effects of AEDs.

Adult↗
PubMed1995

Decreased alloreactivity after vaccination against hepatitis B.

The beneficial effect of blood transfusions on renal allografts disappeared at about the same time when hepatitis B vaccination was introduced in dialysis patients. To determine possible immunosuppressive effects of hepatitis B vaccination, we studied alloreactivity during the course of immunization. Fourteen healthy subjects without serological evidence of hepatitis B were routinely immunized against hepatitis B surface antigen. Plasma and mononuclear cells were isolated and frozen before immunization and after vaccination, respectively. Mean alloreactivity measured by [3H]thymidine uptake decreased from 64,772 cpm before immunization to 40,213 cpm after the third immunization. In crossover experiments, cellular modulation and plasma-dependent modulation of alloreactivity were observed. The immunosuppressive effect of plasma taken 4 weeks after the third vaccination correlated (r = 0.9) highly significantly (P < 0.005) with the anti-hepatitis B surface antigen antibody titer. Taken together, our data strongly suggest that hepatitis B vaccination is capable of reducing allogenic reactivity.

Antigen Presentation↗
PubMed1995

[Value of proximal conduction block study in diagnosis of inflammatory neuropathies].

Conduction block is a common finding in inflammatory neuropathies, indicating circumscribed demyelination. Since demyelination and conduction block are often localized proximally, the whole ulnar nerve including its proximal segments was studied fractionally in 31 patients with inflammatory neuropathies. In 5 of 15 patients with Guillain-Barré syndrome, conduction block at the spinal roots was the first electrophysiological finding indicating demyelinating neuropathy. Segmental conduction blocks were also found in 8 of 9 patients with chronic inflammatory demyelinating polyneuropathies (CIDP) and 4 of 4 patients with atypical neuropathies. In 3 patients, multifocal motor neuropathy (MMN) could only be differentiated from motor neuron disease by recording proximal conduction block. Corresponding to clinical recovery, conduction block improved with immunoglobulin therapy in CIDP and MMN patients. The technique of proximal conduction block studies clearly improves the diagnosis of focal demyelination in inflammatory, treatable neuropathies. They should be performed particularly in patients with atypical neuropathies in whom electrophysiological tests of distal nerve segments show normal results.

Adolescent↗