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H J Bittermann

Publications and source records attributed to H J Bittermann.

14 recordsLinked to original sources
PubMed2001

Simultaneous EEG and functional MRI of epileptic activity: a case report.

OBJECTIVES: Attempts to localize the source of epileptic activity by linking electroencephalographic (EEG) abnormalities to blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) signal alterations are hampered mainly by EEG distortions during MRI, subject motion, and unknown hemodynamic response characteristics. METHODS: Using T2*-weighted echo-planar imaging at 2.0 T (2 s temporal resolution, 2 x 2 x 4 mm(3) spatial resolution), this work demonstrates strategies to alleviate some of these problems while studying a patient who had ideopathic generalized epilepsy with poly-spike and slow-wave complexes. RESULTS: Continuous EEG recordings during dynamic MRI (500 ms scanning, 1500 ms delay) and post-examination derivation of an EEG reference function for MRI analysis revealed positive BOLD MRI responses with temporal characteristics similar to those obtained for functional challenges. CONCLUSIONS: The ability to map focal epileptic activity and/or associated cognitive processing provides new potential for both epilepsy research and clinical patient management.

Adult↗
PubMed2001

Fixation-off sensitivity in an adult with symptomatic occipital epilepsy.

An adult patient had EEG occipital spike fixation-off sensitivity and spontaneous occipital seizures due to perinatal asphyxia with bioccipital hemorrhage. EEG abnormalities consisted of repetitive posterior spikes that occurred when the eyes were closed and other conditions of fixation-off. Magnetic resonance imaging (MRI) documented severe posterior lesions with wallerian degeneration of the optic radiation. Electron capture detector single-photon emission computed tomography (ECD-SPECT) during the state of fixation-off showed regional hyperperfusion in the right posterior regions. We suggest that partial denervation of the primary visual cortex in this patient resulted in an increased cortical excitability and that the inhibitory effect of central vision and fixation leads to a suppression of spontaneous epileptic activity. This unusual symptomatic case may serve as a model for the pathophysiology in the more often reported cases of idiopathic benign epilepsy syndrome of childhood.

Adult↗
PubMed2000

Adult myoclonic epilepsy: a distinct syndrome of idiopathic generalized epilepsy.

The authors present 11 cases of idiopathic generalized epilepsy that began in adulthood at a mean age of 39 years. All patients had myoclonic jerks, five had absence seizures, and nine had infrequent generalized tonic-clonic seizures. A majority had a family history of seizures. EEG in all patients showed generalized epileptiform abnormalities, whereas neuroimaging and neurologic examination results were normal. This series appears to represent a previously undescribed idiopathic generalized epilepsy syndrome of adult myoclonic epilepsy.

Adult↗
PubMed1999

Cisternal S100 protein and neuron-specific enolase are elevated and site-specific markers in intractable temporal lobe epilepsy.

In the brain, S100 protein and neuron-specific enolase (NSE) are mainly found in glial cells and neurons, respectively. We investigated concentrations of S100 protein and NSE in cisternal cerebrospinal fluid obtained during implantation of foramen ovale electrodes in eight patients with temporal lobe epilepsy (TLE). In addition, the meningeal markers cystatin-C and beta-trace as well as total protein were measured. Patients with trigeminal neuralgia (TN) undergoing glycerol rhizotomy served as controls. S100 protein and NSE levels ipsilateral to the site of seizure onset were significantly higher than in TN. Contralateral TLE values were also markedly but not significantly elevated. The meningeal markers cystatin-C and beta-trace protein as well as total protein did not differ in TLE and TN. We conclude that interictal temporal lobe dysfunction corresponds with neuronal and glial marker elevations in the extracellular space and that site-specific elevations may predict the site of seizure origin biochemically.

Adult↗
PubMed1998

[Juvenile myoclonic epilepsy (Janz syndrome). A well-known epilepsy syndrome?].

Juvenile myoclonic epilepsy (JME) was described electroclinically by Janz and Christian in 1957 and consists of myoclonic jerks in varying combination with the absence of seizures and generalized tonic-clonic seizures, a typical circadian distribution on awakening, sleep deprivation, alcohol consumption and flickering stimuli as characteristic precipitating factors, typical EEG abnormalities with generalized epileptiform discharges, normal physical and neuroradiological findings, and often a family history of epilepsy. Although the misdiagnosis of this well-classified and easily treatable syndrome is supposed to occur rarely in Germany, we retrospectively investigated how often the wrong initial classification had been made among patients who were finally treated in our outpatient epilepsy unit. Between 1993 and 1995, 30 patients with a typical JME-like symptom constellation were identified who had been misdiagnosed initially. In all patients, localization-related epilepsy had been classified, although regional EEG abnormalities were rare (n = 5). All patients reported the typical circadian distribution, abnormal neuroradiological findings were absent, and typical EEG abnormalities were present in all cases. Under treatment with appropriate antiepileptic drugs 97% of the patients became almost completely seizure-free. Even 40 years after the first description of the syndrome, JME is an underdiagnosed illness. The generally positive course underlines the importance of its correct identification.

Adolescent↗
PubMed1998

The lateralizing value of ictal clinical symptoms in uniregional temporal lobe epilepsy.

In order to assess the lateralizing value of several ictal and postictal clinical symptoms in temporal lobe epilepsy (TLE), we analyzed 89 seizures of 20 left dominant patients with intractable left (n = 9) versus right (n = 11) TLE who had undergone successful anterior temporal lobectomy. In left TLE, movement arrest at seizure onset, postictal dysphasia > 120 s and postictal dyslexia > 180 s were the most typical findings and associated with a sensitivity of 94, 94, and 100%, respectively. The highest specificity of 100% each was evident for contralateral versions of eyes and head and dystonic posturing. In right TLE, the highest sensitivity was seen for whole-body movements at seizure onset, postictal dysphasia < 120 s and postictal dyslexia < 180 s with figures of 82, 87, and 93%, respectively. As compared to left TLE, contralateral version and dystonic posturing, ictal speech, and postictal dyslexia < 180 s each had a specificity of 100%. The careful combined analysis of certain ictal clinical signs combined with consistent findings of interictal EEG and neuroimaging studies may be often sufficient to proceed with epilepsy surgery without invasive recordings even if ictal scalp EEG is not unambiguous.

Adolescent↗
PubMed1997

[Topiramate--an effective new anticonvulsant. An open prospective study].

Topiramate is a new antiepileptic drug, which is not yet marketed in Germany. The anticonvulsive activity is probably mediated by sodium-channel blockade combined with gabaergic and weak antiglutamatergic properties. We investigated 23 patients with partial seizures in this open prospective study. The efficacy was analysed under stable concurrent antiepileptic drugs. Two of the patients became seizure free. Ten patients had a reduction of seizure frequency of at least 50%. The responder rate was 57%. The maximum daily dosages were 400 to 850 mg. Side-effects without relationship to dose were nervousness and aggression. In two patients an psychotic episode occurred. Dose-related side-effects were ataxia, dizziness, somnolence and dysarthria. This study is underlining that topiramate is efficacious in the treatment of partial onset seizures but also associated with a narrow therapeutic width.

Adult↗
PubMed1997

Isolated ataxia as an idiosyncratic side-effect under gabapentin.

Gabapentin has been accepted worldwide as a novel antiepileptic drug with a favourable tolerability profile. However, movement disorders have been reported previously as rare side-effects in individual patients. We report on two patients who developed isolated severe ataxia under low-dose gabapentin which resolved abruptly after discontinuation of the drug. This side-effect probably resembled a rare idiosyncratic adverse reaction. We propose the gabapentin-specific neuronal binding site which has a high density in the cerebellum as a possible mechanism of action and suggest that the initiation of gabapentin requires caution if pre-existing cerebellar function impairment is evident.

Acetates↗
PubMed1995

Loss of alleles in brain tumours: distribution and correlations with clinical course.

Gliomas (n = 44) and meningiomas (n = 24) of different grades of malignancy were analysed for allele losses at loci on chromosomes 10, 13, 17 and 22. Deletions of genetic material on these chromosomes occurred in gliomas without being restricted to any histological entity. The frequency of chromosome-10-specific allele losses increased significantly with the age of the patients and with the grade of malignancy of the tumours. Deletions of chromosome 10 material were associated with a poor prognosis. The glioblastomas of patients aged over 70 years lacked the loss of the entire chromosome 10, even in tumours with EGFR gene amplification. Deletions at loci of chromosomes 13, 17 and 22 were observed in 18-32% of all gliomas, independent of grade of malignancy, patients' age, EGFR gene amplification and clinical course. Only chromosome-22-specific allele losses were found preferentially in gliomas of female patients. Loss of chromosome 22 alleles in 44% was the only mutation detected in meningiomas. This occurred independently of grade of malignancy and biological factors.

Adolescent↗
PubMedDate not supplied

Moderate alcohol consumption in social drinkers raises plasma homocysteine levels: a contradiction to the 'French Paradox'?

Evidence from observational studies suggests that elevated levels of homocysteine are associated with an increased risk of cardiovascular diseases. We assessed whether moderate alcohol intake in healthy social drinkers, suggested to be cardioprotective according to the 'French paradox', influences the cardiovascular risk factor homocysteine. A total of 60 normal nourished subjects who had no evidence of vascular disease or other risk factors for hyperhomocysteinaemia were assigned to receive mineral water or 30 g of alcohol per day (as beer, red wine or spirits) for a period of 6 weeks. Homocysteine levels of social drinkers, independent of which beverage was consumed, increased during the observation. We postulate that elevated levels of homocysteine in social drinkers with regular moderate alcohol intake are at risk of developing cardiovascular diseases, which contradicts the suggested cardioprotection of alcohol according to the 'French paradox'.

Adult↗