Biomedical subjects

J F Hulihan

Publications and source records attributed to J F Hulihan.

9 recordsLinked to original sources

PubMed2006

Topiramate in essential tremor: a double-blind, placebo-controlled trial.

BACKGROUND: Essential tremor is most prevalent and most disabling in older patients. Additional therapies are required for patients with an inadequate response or intolerable side effects. In small trials, topiramate appeared to be beneficial in essential tremor. METHODS: In this multicenter, double-blind, placebo-controlled, parallel-design trial, patients with moderate to severe essential tremor of the upper limbs were randomized to 24 weeks of treatment with placebo or topiramate (target dose, 400 mg/day) as monotherapy or as an adjunct to one antitremor medication. The primary efficacy variable was the final visit tremor score based on the Fahn-Tolosa-Marin Tremor Rating Scale (TRS). RESULTS: The intent-to-treat population was 208 patients (topiramate, 108; placebo, 100). The final visit score (last observation carried forward) was lower in the topiramate group than with placebo (p < 0.001). Mean percentage improvement in overall TRS scores was 29% with topiramate at a mean final dose of 292 mg/day and 16% with placebo (p < 0.001). Topiramate was associated with greater improvement in function and disability (p = 0.001). A between-group difference (p < 0.001) was observed at the first on-treatment visit at 4 weeks when the target topiramate dose was 100 mg/day (mean achieved dose, 62 +/- 9 mg/day). The most common treatment-limiting adverse events in topiramate-treated patients were paresthesia (5%), nausea (3%), concentration/attention difficulty (3%), and somnolence (3%). Adverse events were treatment limiting in 31.9% of topiramate patients and 9.5% of placebo patients. CONCLUSIONS: Topiramate was effective in the treatment of moderate to severe essential tremor. Tremor reduction was accompanied by functional improvements, such as in motor tasks, writing, and speaking.

Adult↗

PubMed2003

Differential cognitive and behavioral effects of topiramate and valproate.

OBJECTIVE: Cognitive effects have been reported during topiramate (TPM) treatment, but effects relative to standard antiepileptic drugs are unclear. METHODS: The authors compared TPM and valproate (VPA) added to carbamazepine (CBZ) in adults with partial seizures. A comprehensive neuropsychological test battery including cognitive, mood, and quality of life measures was used in this multicenter, randomized, double-blind study. After a 4-week baseline, study drug was titrated over 8 weeks to target dosages of 400 mg/d TPM, 2,250 mg/d VPA, or placebo and then maintained for an additional 12 weeks. The neuropsychological test battery was administered at baseline and at the end of titration and maintenance periods. RESULTS: Slightly more patients on TPM dropped out. Neuropsychological data at all three test periods were available for 62 patients. At the end of maintenance, effects of TPM and VPA were comparable, except for two variables (Symbol Digit Modalities Test and Controlled Oral Word Association Test), in which TPM had greater negative effects relative to VPA. The statistical differences appeared to be due in large part to a small subset of patients who were more negatively affected by TPM. Cognitive effects of TPM relative to VPA were greater at the end of titration than at the end of maintenance. CONCLUSIONS: With adjunctive therapy at moderate dose escalation rate, the cognitive effects of TPM are slightly worse overall than VPA in patients who tolerate therapy over several months.

Adolescent↗

PubMed1997

Seizures in special populations. Children, the elderly, and patients with coexistent medical illness.

Epilepsy management may need to be modified in certain patient groups. The management of epilepsy in all age-groups, and particularly in children, may be best approached from a disease-based model that recognizes specific epilepsy syndromes. Accurate diagnosis of pediatric epilepsy syndromes allows the physician to improve medication selection, estimate duration of treatment, and counsel patients and family members about aggravating factors and prognosis. Epilepsy management in elderly patients requires knowledge of age-related changes in the metabolism and protein binding of anticonvulsants and how these changes affect use of particular antiepileptic drugs. Concurrent medical illness, especially renal and hepatic disease, may alter drug distribution, metabolism, and excretion in some patients. In addition, a number of medications used to treat coexistent medical or psychiatric illness are associated with seizure provocation. Knowledge of these factors can improve epilepsy management in special patient populations.

Aged↗

PubMed1995

Stump pressure, electroencephalographic changes, and the contralateral carotid artery: another look at selective shunting.

BACKGROUND: Selective shunting during carotid endarterectomy is associated with the lowest operative stroke rate; therefore, patient selection for carotid shunting is critical. Electroencephalography (EEG) can detect ischemic brain cell dysfunction before irreversible injury. The carotid stump back pressure (CSP) has been inconsistent in determining the need for shunting, and contralateral carotid disease has had a variable impact. The purpose of this study was to evaluate CSP and operative EEG changes, and to determine the effect of contralateral carotid artery disease on determining the need for carotid shunting. METHODS: In 140 consecutive carotid procedures, operative EEG and CSP were monitored, and contralateral carotid disease was documented. The carotid stump pressure/mean arterial pressure index (CSP/MAP) was also calculated to determine if this was a better indicator of the need for shunting than the CSP alone. RESULTS: There was a 58% incidence of EEG changes when the CSP was < or = 25 mm Hg, 32% with a CSP of 26 to 50 mm Hg, and 4% with a CSP > 50 mm Hg. There was a 43% incidence of EEG changes and lower CSP among patients with a contralateral occlusion, both of which were significantly different from patients with a patent contralateral carotid artery. Three patients with CSP > 50 mm Hg had EEG changes, but none had a contralateral occlusion. Two patients had permanent neurologic deficits, and 2 had transient deficits. Excluding combined procedures, operative stroke rate was 0.8%. CONCLUSIONS: A CSP of < 50 mm Hg achieved a sensitivity of 89% in patients who developed ischemic EEG changes during carotid clamping, and a pressure > 50 mm Hg had a negative predictive value of 96%. However, a CSP of < 50 mm Hg had a positive predictive value of only 36%. Neither the addition of the status of the contralateral carotid artery or the calculation of the CSP/MAP improved the sensitivity of the CSP in determining the need for shunting. Operative EEG monitoring remains the most sensitive guide to carotid shunting in patients undergoing carotid endarterectomy under general anesthesia.

Adult↗

PubMed1994

Electroencephalographic sleep patterns in post-anoxic stupor and coma.

We analyzed EEGs performed over a 6-month period on patients with impaired consciousness following acute hypoxia or anoxia. There were 17 EEGs performed on 14 patients. Nine of the 17 records contained spindle activity. Spindles were present in 6/8 EEGs in stuporous patients, in 3/9 EEGs in comatose patients, in 6/10 patients who eventually died, and in 3/3 patients who regained consciousness. When spindle activity or background reactivity were absent, outcome was poor, ie, death or a persistent vegetative state. The presence of EEG spindle activity after hypoxic or anoxic injury did not indicate a favorable prognosis, but the absence of spindles or EEG background reactivity was associated with a poor outcome.

Coma↗

PubMed1991

Clinical and electrophysiological assessments in ALS patients.

Since the relationships between traditional assessments in ALS patients have not been defined, three clinical and four electrophysiological assessments were performed in a cross-sectional study of 87 ALS patients. The clinical assessments produced Norris ALS scores, muscle strength scores and illness durations (DUR). The electrophysiological assessments produced scores for motor unit interference pattern, denervation potentials, compound muscle action potential, and fasciculations. The individual muscle scores were averaged to produce mean scores, and Spearman rank correlations were performed on the mean scores. The association between Norris ALS and mean muscle strength (MMS) scores is significant (p less than .001, rs = 0.84), and these scores are significantly correlated with mean interference pattern (0.77, 0.82), mean denervation potential (-0.63, -0.70), and mean compound muscle action potential scores (0.55, 0.60), respectively. Correlations between IP and DP scores (-0.71), IP and CMAP scores (0.62), and DP and CMAP (-0.56) scores are also significant. Scatterplots of the data and regression lines suggest linear relationships between each of these assessments. Illness duration and fasciculation scores are not strongly correlated (rs less than 0.55) with any of the other clinical or electrophysiological assessments.

Amyotrophic Lateral Sclerosis↗

PubMedDate not supplied

Bilateral periodic lateralized epileptiform discharges in Mycoplasma encephalitis.

Status epilepticus and prolonged coma developed in two patients with respiratory tract infections caused by Mycoplasma pneumoniae. Serial electroencephalography initially revealed bilateral, independent, periodic, lateralized epileptiform discharges. This pattern was replaced several days later by other electroencephalographic abnormalities.

Brain Damage, Chronic↗

PubMedDate not supplied

Long-term follow-up of stereotactic lesionectomy in partial epilepsy: predictive factors and electroencephalographic results.

We performed an extended follow-up study assessing the efficacy of stereotactic lesionectomy in 23 patients with foreign-tissue lesions and intractable partial epilepsy. Sixteen lesions involved functional or eloquent cortex as determined by anatomic localization. By definition, the surgical objective in these patients was excision of the lesion, and not the surrounding cerebral cortex. The mean duration of follow-up was 48.5 months (range 26-69 months). Seventeen patients (74%) had a significant reduction in seizures (greater than or equal to 90%) after lesionectomy. Thirteen patients (56%) had a class I operative outcome (seizure-free, single seizure episode, or auras only). Five of these patients were successfully discontinued from antiepileptic drug (AED) therapy. Patients with temporal lobe lesions were statistically less likely to be rendered seizure-free (p less than 0.05). Age at operation, duration of epilepsy, and underlying pathology were not significant predictors of seizure outcome. The anatomic distribution of extracranial EEG recorded epileptiform activity did not appear to be an important determinant of outcome. The absence of interictal epileptiform activity in the 3-month postoperative EEG correlated with a significant reduction in seizures. Long-term follow-up indicates that lesionectomy may be effective in select patients with medically refractory partial seizure disorders.

Adolescent↗

PubMedDate not supplied

Parietal lobe lesional epilepsy: electroclinical correlation and operative outcome.

We retrospectively studied ictal behavior, extracranial EEG, and operative outcome in 10 consecutive patients with intractable partial epilepsy of presumed parietal lobe origin who received a lesionectomy, i.e., resection of the neuroimaging-identified abnormality, at the Mayo Clinic. Nine patients had a pathologically verified foreign-tissue lesion, e.g., tumor or vascular malformation, and 1 patient had gliosis. All patients with foreign-tissue lesions were rendered seizure-free. The patient with gliosis experienced a reduction in seizure tendency. There were no operative complications. The most common seizure type was a simple partial seizure with visual, motor, or sensory symptoms (n = 8). Complex partial seizures (n = 5) and secondarily generalized tonic-clonic seizures (GTC, n = 2) were also observed. The ictal behavior was often nonspecific although useful in identifying lateralization of the epileptogenic zone. Extracranial interictal and ictal EEG changes were unreliable markers of the parietal lobe origin of seizure activity. Lesionectomy without chronic intracranial monitoring or functional mapping may be an effective and safe alternative surgical procedure in patients with partial epilepsy related to parietal lobe lesions.

Adolescent↗