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Biomedical subjects

F S Leijten

Publications and source records attributed to F S Leijten.

13 recordsLinked to original sources
PubMed2001

Activation of interictal spiking in mesiotemporal lobe epilepsy by propofol-induced sleep.

The objective of this study was to test whether low-dose propofol increases the number of interictal spikes in patients with mesiotemporal lobe epilepsy, and to determine whether this is the result of intrinsic properties and is restricted to the primary epileptogenic focus. Controlled infusion of propofol in step-up/-down target concentrations of 0, 0.3, 0.6, and 0.8 mg/L was administered to 10 patients during a 3.5-hour daytime EEG registration. The number of spikes were counted and related to propofol concentration and sleep level. Results were compared with a spontaneous, nocturnal first sleep cycle in 9 of 10 patients. All patients entered nonrapid eye movement 1 sleep during propofol administration, and 8 reached nonrapid eye movement 2 sleep. In 7 patients who showed spikes, spikes were related to sleep (P < 0.05) and not to increasing (P = 0.1) or decreasing (P = 0.5) propofol concentration. Six of nine patients showed more spikes during spontaneous (nocturnal) sleep than during propofol-induced sleep. Contralateral spiking was not suppressed selectively. Low-dose propofol is a safe means of increasing spiking in these patients because it induces sleep. There were no signs of an intrinsic epileptogenicity of propofol or a selective effect on ipsilateral spikes. Controlled sleep induction will increase the yield of interictal spikes during short interictal recordings such as in magnetoencephalography.

Adult↗
PubMed2000

["Critical-illness" polyneuropathy and -myopathy].

Critical-illness polyneuropathy and myopathy (CIPNM) can be considered a part of the syndrome of multiple organ dysfunction. CIPNM is the commonest cause of muscle weakness acquired in the intensive care unit. Its incidence is 35-80% during prolonged mechanical ventilation. For a (differential) diagnosis, electrophysiological investigations are usually necessary, and sometimes a muscle biopsy. CIPNM may be induced by triggering of the immune response leading to increased vascular permeability with tissue invasion of inflammatory cells and local damage. There is a relation between myopathy and medication, notably corticosteroids. Clinical improvement usually follows when the CIPNM patient survives the underlying disease, but weaning from artificial ventilation is often difficult, and rehabilitation prolonged.

Critical Care↗
PubMed1999

[Epileptic seizures in the elderly; diagnostic problems].

Epilepsy is increasingly becoming a disease of the elderly. Specific, age-related problems make its diagnosis often difficult. The signs and symptoms may not be recognized by patient, family or physician. The (hetero)anamnesis is often incomplete and confounded by atypical or unrelated complaints. Classical signs of lobar epilepsy are often indistinct. Physical examination and neuroimaging may provide misleading clues. Electroencephalography has a low sensitivity in the elderly. Nonconvulsive status epilepticus is especially difficult to recognize clinically, and has a high morbidity. Still, epilepsy remains a treatable condition so that a thorough diagnostic workup is warranted in all cases.

Aged↗
PubMed1998

Light diffusion in photosensitive epilepsy.

Photosensitivity is usually tested by intermittent photic stimulation. Photoparoxysmal responses in the EEG are enhanced when the eyes remain closed during stimulation. We tested the hypothesis that this is due to diffusion of light by the eyelids. In 25 photosensitive patients, conditions 'eye closure', 'eyes closed', 'eyes open' and 'eyes open with diffuser' were tested for frequencies of 2-60 Hz. Additional influences of a red filter and fixation were also examined. The photosensitivity range was maximal in the condition 'eyes open with diffuser', due to an increase of the upper limit to a median 60 Hz (range 25-60), from 35 (15-50) Hz with eyes open, 37.5 (25-60) Hz with eyes closed and 40 (23-60) Hz with eye closure (P = 0.0002). This effect was attenuated in patients on valproic acid and with the use of a red or white filter. Testing with a diffuser was more sensitive than without, except for one patient who was photosensitive only in the eye closure condition. The influence of the eyelids on photosensitivity can be explained by diffusion of light, attentuated by an intensity loss. Use of a diffuser may simplify testing for photosensitivity in the EEG laboratory. The diffusion effect may explain seizure susceptibility in front of 50 and 60 Hz television screens.

Adolescent↗
PubMed1996

Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator.

BACKGROUND: Acute axonal polyneuropathy has been found in patients with multiple organ dysfunction syndrome. This 'critical illness polyneuropathy' (CIP) has been associated with difficult weaning from the ventilator in retrospective studies. OBJECTIVE: To test the hypothesis that CIP is related to the degree and number of organ dysfunctions, and to weaning problems. DESIGN: Prospective study of 18 months. SETTING: A multidisciplinary intensive care unit in a general hospital SUBJECTS: Thirty-eight patients under 75 years of age who had been mechanically ventilated for more than 7 days, without previous signs of or risk factors for polyneuropathy. MEASURES: Organ dysfunctions were quantified using a dynamic scoring system (0-12 points). Electromyography studies were performed during mechanical ventilation to identify patients with and without CIP. RESULTS: CIP was present in 18 out of 38 patients and associated with an increased organ dysfunction score (5.3 +/- 1.8 vs. 3.6 +/- 1.5; p = 0.003) and number of organs involved [median (range): 4 (3-5) vs. 2 (1-4); p = 0.009], in particular cardiovascular (p = 0.003), renal (p = 0.04), and hematopoietic failure (p = 0.04). Patients with polyneuropathy were ventilated longer, but this was not clearly due to more difficult weaning [median: 16.5 (1-48) vs. 9.5 (1-38) days; p = 0.26]. Polyneuropathy was present in 2 of 4 patients with normal weaning. CONCLUSIONS: Axonal polyneuropathy is related to the severity of multiple-organ-dysfunction syndrome. Its presence does not necessarily implicate difficult weaning from artificial ventilation.

APACHE↗
PubMed1995

The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation.

OBJECTIVE: To test the hypothesis that prolonged motor recovery after long-term ventilation may be due to polyneuropathy and can be foreseen at an early stage by electromyography (EMG). DESIGN: Cohort study with an entry period of 18 months. Polyneuropathy was identified by EMG studies in the intensive care unit (ICU). During a 1-year follow-up, amount of time was recorded to reach a rehabilitation end point. SETTING: The general ICU of a community hospital. PATIENTS: Fifty patients younger than 75 years who were receiving mechanical ventilation for more than 7 days. MAIN OUTCOME MEASURES: A rehabilitation end point was defined as return of normal muscle strength and ability to walk 50 m independently. RESULTS: In 29 of 50 patients, an EMG diagnosis of polyneuropathy was made in the ICU. Patients with polyneuropathy had a higher mortality in the ICU (14 vs 4; P = .03), probably related to multiple organ failure (22 vs 11; P = .08) or aminoglycoside treatment of suspected gram-negative sepsis (17 vs 4; P = .05). Rehabilitation was more prolonged in 12 patients with polyneuropathy than in 12 without polyneuropathy (P = .001). Of nine patients with delays beyond 4 weeks, eight had polyneuropathy, five of whom had persistent motor handicap after 1 year. In particular, axonal polyneuropathy with conduction slowing on EMG indicated a poor prognosis. CONCLUSIONS: Polyneuropathy in the critically ill is related to multiple organ failure and gram-negative sepsis, is associated with higher mortality, and causes important rehabilitation problems. EMG recordings in the ICU can identify patients at risk.

APACHE↗