Biomedical subjects

J Reiher

Publications and source records attributed to J Reiher.

9 recordsLinked to original sources

PubMed1992

Partial status epilepticus: short-term prediction of seizure outcome from on-line EEG analysis.

Several combinations of ictal and interictal EEG abnormalities have previously been identified in partial status epilepticus (PSE). Some are associated with a consistently higher seizure index than others. On-line analysis of the initial segments of the EEG monitoring and familiarization with seizure indices corresponding to each combination may provide useful clues to rapidly foretell short-term seizure recurrence in patients with PSE. Referring to matrices reconstructed from an analysis of the initial min of the monitoring in 64 patients with recorded PSE can help to identify quickly those patterns which are most often associated with the highest probability of relapsing seizures. Awareness of the probability range of recording additional seizures observed with each of these various patterns may provide guidelines for judicious patient enrollment and for meaningful assessment of results in prospective studies of treatment efficacy in PSE.

Action Potentials↗

PubMed1991

Periodic lateralized epileptiform discharges with transitional rhythmic discharges: association with seizures.

Low amplitude rhythmic discharges (RDs) closely associated in time and in spatial distribution to inter-ictal epileptiform discharges are not seen in scalp EEGs of patients with non-periodic focal epileptiform discharges (NPEDs) but they are unexpectedly common in patients with periodic lateralized epileptiform discharges (PLEDs). A classification of PLEDs into PLEDs Proper (PLEDs without RDs), and PLEDs Plus (PLEDs with RDs) is proposed. Such a classification is useful for an easier appreciation of PLEDs' pleomorphism. It underscores the changing periodicity of PLEDs and allows for a more inclusive definition of the phenomenon than the one reported by the literature. It also emphasizes the importance of recognizing RDs in scalp EEGs as transitional anomalies intercalated between inter-ictal PLEDs and ictal seizure discharges, analogous to those observed by Ralston in animal models. Indeed, the occurrence of recorded seizures is higher in patients with PLEDs Plus than in those with PLEDs Proper or NPEDs.

Electroencephalography↗

PubMed1991

Retrospective inventory of EEG abnormalities in partial status epilepticus.

In this retrospective study, EEG activity in partial status epilepticus (PSE) was classified into different patterns from analysis of both ictal and interictal discharges. In 64 patients with recorded PSE, continuous seizures and closely spaced seizures interrupted by only brief flat periods were uncommon. PLEDs, defined as classic periodic lateralized epileptiform discharges, and PLEDs Plus, defined as PLEDs associated with stereotyped low amplitude, were the most common abnormalities. PLEDs and PLEDs Plus can each occur alone or sequentially (sequential PLEDs) between consecutive seizures. The quantity of ictal activity was significantly lower with PLEDs, sporadic spikes and with the absence of epileptiform abnormalities than with PLEDs Plus and sequential PLEDs. EEG monitoring is important to gauge the effectiveness of treatment, particularly in patients with patterns associated with a high incidence of seizure activity, namely continuous seizures with or without flat periods, sequential PLEDs and PLEDs Plus. From serial recordings, a sequence was reconstructed which may be relied upon to further assess the need for additional energetic therapeutic measures. The reconstructed sequence differed in patients with chronic lesions since sequential PLEDs and PLEDs Plus were identified exclusively in patients with acute or subacute lesions.

Adult↗

PubMed1991

Clinical correlates and electroencephalographic characteristics of two additional patterns related to 14 and 6 per second positive spikes.

Two additional patterns, minuscule 28 per second positive spikes and huge N-shape potentials, have been identified exclusively in the EEGs of patients with 14 and 6 per second positive spikes. They occur predominantly during drowsiness and light sleep, usually in children, seldom in young adults. Their presence adds little to the clinical relevance of positive spikes. Familiarization with the N-shape potentials--the commoner of the two patterns--is important, lest they are mistaken for interictal abnormalities of significance such as atypical spike-wave complexes.

Adult↗

PubMed1989

Transient anosognosia for episodic hemiparesis: a singular manifestation of TIAs and epileptic seizures.

Anosognosia is a well-known manifestation of non-dominant parietal lobe lesions and typically lasts a few days. That anosognosia may last only a few minutes to a few hours, as observed in six patients, has not been reported. In five patients, transient anosognosia for equally brief left-sided hemiparesis was a manifestation of transient ischemic attacks (TIAs). In the sixth patient, anosognosia for both a left-sided motor seizure and a subsequent brief left hemiparesis could best be explained by an epileptic ictal and post-ictal transient dysfunction of the non-dominant parietotemporal cortex. Prompt recognition of transient anosognosia, whether ischemic or epileptic, is mandatory for proper diagnosis and for rapid initiation of specific therapy.

Aged↗

PubMed1989

Temporal intermittent rhythmic delta activity (TIRDA) in the diagnosis of complex partial epilepsy: sensitivity, specificity and predictive value.

Temporal interictal rhythmic delta activity or TIRDA was found in 45 of the 127 recordings of patients with complex partial epilepsy (CPE) referred for both awake and sleep EEG. TIRDA was more abundant during drowsiness and light sleep; it occurred more characteristically as trains of 50-100 microv sinusoidal or saw-toothed 1-4Hz activity, recorded predominantly from anterior temporal regions. When occurring bilaterally and independently, TIRDA varied from side to side. TIRDA is often found in association with anterior temporal spikes or sharp waves (TS) particularly during sleep, as observed in 43 out of 45 EEGs. TIRDA can nevertheless occur as an isolated abnormality, as noted in two sleep and 12 awake study recordings. Because of its high specificity and positive predictive value over a large range of prevalence, TIRDA should be singled out as an accurate interictal indicator of CPE. In patients with isolated TIRDA, the cost of prolonged EEG recording during sleep for the purpose of activating TS has to be weighed against the yield of eventually confirming the obvious.

Adult↗

PubMed1979

Recording small sharp spikes with depth electroencephalography.

Two patients with intractable seizures and focal temporal sharp waves also had small sharp spikes as incidental findings in their scalp electroencephalograms. Depth electroencephalography verified the intracerebral origin of the small sharp spikes and differentiated them from the more significant epileptiform abnormalities.

Adolescent↗

PubMed1977

Wicket spikes: clinical correlates of a previously undescribed EEG pattern.

From an analysis of the electroencephalograms of 4,458 patients who underwent recording during both wakefulness ans sleep, through the years 1969 to 1975, wicket spikes-- recorded in 39 patients-- may be described as follows: They were found during both wakefulness ans sleep, almost exclusively in adults. Their cardinal feature is a changing mode of occurrence through any single recording: from intermittent trains of more or less sustained, arciform, discharges resembling mu rhythm, to sporadic, urinary, single spikes. When occurring singly, wicket spikes can be mistaken for anterior or middle temporal spikes, since they predominate in eith er area, and since they share with them other characteristics such as amplitude (60 to 210 microvolts), polarity (surface negative) duration, and configuration. Wicket spikes should not be considered interictal abnormalities; they do nor correlate with epilepsy or with any particular symptom complex.

Electroencephalography↗

PubMed1977

[Headache simulating meningeal hemorrhage].

That migraine can present with a severe headache of sudden onset mimicking that of subarachnoid hemorrhage--the so-called "complicated migraine with meningeal manifestations" of Pearce and Foster--is not readily appreciated. Over the past three years, seven patients have been referred to us with a presumable diagnosis of subarachmoid hemorrage. In each one of these patients, the clinical features (an explosive headache, relapsing in three, and a normal neurological examination) together with appropriate laboratory investigations (cerebro-spinal fluid analysis, electroencephalography, echoencephalography, brain scan, arteriography, pneumoencephalography) have ruled out the diagnosis of subarachnoid hemorrhage, as well as less common causes of explosive headaches such as ball-valve tumors of the ventricular system, intra-cerebral hemorrhage, hemorrhage into a tumor. In three out of these seven patients, there was no history of migraine. Bening explosive headaches mimicking subarachnoid hemorrhage, occurring in patients with or without antecedents of migraine, are not as unusual as one might conclude from a review of the literature. Proper recognition of this syndrome is important since it might help to sort out those patients with explosive headaches who need not be submitted indiscriminately to risk-fraught procedures.

Adult↗