Biomedical subjects

K Alper

Publications and source records attributed to K Alper.

At least 19 recordsLinked to original sources

PubMed2001

Progression of postictal to interictal psychosis.

PURPOSE: To describe a case series of patients with both postictal psychosis (PIP) and chronic interictal psychosis (IIP). METHODS: We retrospectively reviewed the records of 43 patients with PIP from a comprehensive epilepsy center to find evidence of both PIP and IIP in the same patient. RESULTS: Six (13.9%) of the 43 patients met all the criteria for both PIP and IIP. Five of our six patients had multiple documented PIPs before they became chronically psychotic. The range of length of time between PIP and IIP was 7 to 96 months. Postictal and interictal psychotic behavior was similar or identical in five of six cases. CONCLUSIONS: The results of this study suggest a progression from PIP to IIP: there is a similarity between the symptoms of the two psychoses, a history of multiple PIPs before the first IIP, and a period of months to years between PIP and IIP onset.

Adult↗

PubMed2001

Nondominant hemisphere lesions and conversion nonepileptic seizures.

To explore the hypothesis that lateralized hemispheric dysfunction may contribute to the development of conversion symptoms, the authors studied frequency of unilateral cerebral physiological or structural abnormalities in 79 consecutive patients with conversion nonepileptic seizures (C-NES), who were also compared with two groups of epilepsy patients without C-NES. Sixty (76%) of the C-NES patients had unilateral cerebral abnormalities on neuroimaging, of which 85% were structural. Ictal or interictal epileptiform abnormalities on EEG were found in 78% of C-NES patients and focal slowing in another 10%. Fifty (63%) of the C-NES patients had both structural and epileptiform abnormalities. Among the 60 with unilateral abnormalities, 43 (71%) had right hemisphere structural lesions or physiologic dysfunctions (C-NES>non-C-NES, P<0.02). This study supports prior studies and clinical observations that cerebral dysfunction can contribute to the pathogenesis of conversion disorder, and that nondominant hemisphere dysfunction may play a greater role.

Adolescent↗

PubMed2001

Premorbid psychiatric risk factors for postictal psychosis.

Postictal psychosis (PIP) is a common and clinically significant sequela of inpatient epilepsy monitoring. A series of 622 patients with complex partial epilepsy undergoing video-EEG evaluations as candidates for epilepsy surgery were evaluated, by structured psychiatric interview, for individual and family psychiatric histories, depression, anxiety, and features of personality disorders. No patient had psychotic symptoms at baseline. Twenty-nine developed a PIP episode during monitoring. The a priori hypotheses were that patients with PIP would have higher baseline schizotypal and paranoid personality ratings and a greater prevalence of histories of psychiatric treatment and family history of psychotic illness. However, only a higher prevalence of mood disorder among first- and second-degree relatives distinguished the patients who developed PIP on logistic regression analyses (odds ratio=3.49, P=0.001). Possible mechanisms linking vulnerability toward mood disorders and the development of psychotic symptoms in epilepsy are discussed.

Adult↗

PubMed2000

Emotional outbursts and post-traumatic stress disorder during intracarotid amobarbital procedure.

Severe emotional outbursts (SEOs) during intracarotid amobarbital procedures (IAP) rarely jeopardize preoperative language and memory testing. Four of four patients (100%) with outbursts had experienced significant emotional trauma (three were raped and one witnessed a decapitation), compared with 26 of 546 patients (4.8%) without outbursts (chi2 = 69.8, p < 0. 0001). Evocative injections were ipsilateral to seizure focus. IAP may disrupt emotional balance in some traumatized patients. Counseling may prevent SEOs.

Adolescent↗

PubMed2000

Psychotropic medication use in patients with epilepsy: effect on seizure frequency.

Physicians are often reluctant to use psychotropic medications in epilepsy patients with psychiatric disorders because of concern over the potential risk for lowering seizure threshold. This study assesses retrospectively the impact of psychotropic medications on seizure frequency in 57 patients seen consecutively at an epilepsy center. During psychotropic drug therapy, seizure frequency decreased in 33% of patients, was unchanged in 44%, and increased in 23%. Mean seizure frequency was not statistically different between pre-treatment and treatment periods (t = 0.23, df = 56). Simultaneous adjustments in antiepileptic drug regimen could not account for the findings. Results support the position that psychotropic medications, introduced slowly in low to moderate doses, can be safely used in epilepsy patients with comorbid psychiatric pathology during the regular course of clinical care.

Acute Disease↗

PubMed1998

Correlation of qEEG with PET in schizophrenia.

PET relative metabolism was correlated with quantitative EEG in 9 schizophrenic patients. The PET metabolic regions of interest were the frontal lobes, thalamus and basal ganglia, and right and left temporal lobes. Significant positive correlations were seen for the frontal lobes and delta EEG power, and alpha power with subcortical metabolism. The physiologic plausibility of those correlations is discussed with reference to the possible effect of neuroleptic medication.

Adult↗

PubMed1998

Olfactory reference syndrome in a patient with partial epilepsy.

A 49-year-old man with right temporal lobe epilepsy developed the chronic delusion that his body emitted a foul odor (olfactory reference syndrome). Before the delusional symptoms, he had partial seizures with unpleasant olfactory hallucinations. Subsequently ictal olfactory symptoms abated but a disabling delusional syndrome developed. The only prior case of the olfactory reference syndrome in a patient with epilepsy had a right frontal lesion. The case further supports the association of right hemisphere lesions and delusional disorders.

Epilepsy, Temporal Lobe↗

PubMed1997

Dissociation in epilepsy and conversion nonepileptic seizures.

PURPOSE: We examined the dimensionality of the item content of the Dissociative Experiences Scale (DES) in relation to the clinical diagnosis of conversion nonepileptic seizures (C-NES) versus complex partial epilepsy (CPE). METHODS: The DES was administered to a sex- and age-matched sample of 132 patients with C-NES and 169 with CPE and was factor analyzed with principal components analysis (PCA) with varimax rotation. RESULTS: The mean total DES score was 15.1 in the C-NES group and 12.7 in the CPE group (p = 0.079). The factors obtained by PCA differentiated the CPE and C-NES groups more strongly than did the total DES score. The factor accounting for the most variance, interpreted as "depersonalization-derealization," was significantly greater in C-NES than CPE (p = 0.005). An "absorption-imaginative involvement" factor, which included some of the clinical features of posttraumatic stress disorder was elevated only in subjects reporting histories of childhood abuse (p = 0.001) regardless of the diagnosis of CPE or C-NES. An "amnestic" factor appearing to represent memory problems related to neurologic impairment showed a trend toward elevation in CPE (p = 0.056) and may have confounded the CPE versus C-NES distinction using total DES scores. CONCLUSIONS: The DES has separate underlying dimensions that appear to relate distinctively to depersonalization and derealization, childhood trauma, and neurologic impairment. The heterogeneous item content of the DES is a potential confound that should be appreciated when this instrument is used to study dissociation in neuropsychiatric populations.

Adult↗

PubMed1996

Clinical profile of patients with epileptic and nonepileptic seizures.

Epileptic seizures (ES) and nonepileptic seizures (NES) often coexist in patients with treatment-refractory seizures. There are few data on ictal features of these different seizure types in the same patient. We identified 20 patients with ES from a group of 99 NES patients (ES/NES) and compared this group with patients with only ES or NES. All 20 ES/NES patients developed NES after ES. Clinical features of NES clearly differed from ES in 18 of 20 cases. In patients with ES/NES their ES were similar to seizures in patients with only ES, and their NES were similar to spells in patients with only NES. ES/NES patients were similar to ES patients in electrodiagnostic and neuroimaging studies, and similar to NES patients in psychiatric interviews and inventories. The clinical manifestations of ES and NES in the same patient are usually different. Both types of events may be stereotypic and can be distinguished and characterized during video-EEG recording. Determining what events are more prevalent or disturbing is critical. Psychiatric and antiepileptic drug treatment may be provided accordingly.

Amnesia↗

PubMed1996

Neurometric QEEG studies of crack cocaine dependence and treatment outcome.

This paper presents an overview of the quantitative electrophysiological (QEEC) research on cocaine dependence conducted at Brain Research Laboratories of New York University Medical Center. These studies have demonstrated that subjects with DSM-III-R cocaine dependence (without dependence on any other substance) evaluated in the withdrawal state, have replicable abnormalities in brain function when evaluated at baseline (approximately 5 to 10 days after last crack cocaine use), which are still seen at one and six month follow-up evaluations. These abnormalities were characterized by significant excess of relative alpha power and deficit of absolute and relative delta and theta power. Abnormalities were greater in anterior than posterior regions, and disturbances in interhemispheric relationships were also observed. In addition, QEEC subtypes were identified within the population of cocaine dependent subjects at baseline, and these subtypes were found to be significantly related to subsequent length of stay in treatment. The relationship between these QEEG findings and the neuropharmacology of cocaine dependence is discussed.

Adolescent↗

PubMed1995

Psychiatric classification of nonconversion nonepileptic seizures.

OBJECTIVE: To determine the frequency and type of non-conversion nonepileptic seizures (NES). BACKGROUND: Although conversion disorder is the most common psychiatric disorder among patients with NES, many patients with nonepileptic paroxysmal behavioral events have other psychiatric disorders, with natural histories and treatments different from those of conversion disorder. DESIGN: Retrospective review of a series of consecutive admissions for video-electroencephalography monitoring. All patients identified with NES were interviewed by a psychiatrist. Patients with conversion and other psychiatric disorders were divided into separate groups. SETTING: A comprehensive epilepsy center. RESULTS: Twenty-one patients evaluated for possible epileptic seizures had a psychiatric disorder other than conversion that accounted for their events. Among these patients, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) anxiety disorders (n = 9) were the most common diagnosed category, followed by all forms of psychotic disorders (n = 7) and impulse control problems in the setting of attention deficit disorder residual type (n = 2). In contrast to 71 patients with conversion NES seen over the same period of time, the non-conversion group showed no female predominance and the nonconversion patients were significantly less likely than the conversion patients to have been physically or sexually abused in childhood or adolescence. CONCLUSIONS: These results support the validity of the nosologic distinction of nonconversion from conversion NES and suggest that DSM-III-R anxiety disorders are an important diagnostic confound in clinical epilepsy.

Conversion Disorder↗

PubMed1995

Postictal psychosis: a case control series of 20 patients and 150 controls.

We compared clinical data, EEG, and video-EEG studies in a consecutive series of 20 patients with postictal psychosis (PP) to 150 consecutive epilepsy patients with complex partial (CPS) or generalized tonic-clonic (GTCS) seizures but without PP. There was a lucid interval between last seizure and onset of psychosis ranging from 2.3 to 72 h (mean, 25 h). Duration of PP ranged from 16 to 432 h (mean, 83 h). Age, sex, epilepsy type (partial vs. generalized), and history of febrile seizures were similar in the PP and control groups. Patients with PP had more frequent GTCS during monitoring than controls (2.8 vs. 1.3; P < 0.001). Patients with PP were more likely to have a history of encephalitis (P < 0.0001) and psychiatric hospitalization (P < 0.002). More patients with PP had bilateral interictal epileptiform discharges during monitoring than controls (P < 0.0002). Postictal psychosis most often develops in patients with bilateral dysfunction following a cluster of GTCS.

Adult↗

PubMed1995

QEEG in hemophiliacs with HIV infection.

Conventional visual analysis of the EEG was performed on 320 hemophiliacs infected with HIV, who spanned the range of the Walter Reed (WR) system for classifying clinical stage of HIV infection, and on 50 HIV seronegative hemophiliac controls. Intermittent or paroxysmal slowing was the conventional EEG abnormality most commonly seen in early stages of HIV infection (stages WR1 and 2), with increased focal epileptiform activity and generalized slowing appearing in patients with the full clinical syndrome of AIDS (WR6). Slowing of the manually measured alpha rhythm was noted in stages WR2 and above. Quantitative EEG (qEEG) was obtained in a subset of 103 male HIV seropositive male hemophiliacs and 35 male HIV seronegative hemophiliac controls. The principal findings were a progressive relative increase in theta power with a tendency towards an anterior topographic distribution, and a progressive decline of spectral power in fast alpha relative to slow alpha with increasing severity of HIV disease. Significant qEEG differences from controls were apparent in WR2 subjects (seropositive with lymphadenopathy and without other constitutional symptoms), and were relatively greater in WR3-6 subjects. These results suggest sensitivity of qEEG to early CNS involvement with HIV infection.

Adult↗

PubMed1995

Quantitative EEG characteristics of children exposed in utero to cocaine.

Quantitative EEGs (QEEGs) were evaluated in a group of 6 school age children with in utero cocaine exposure. Their QEEGs showed significant deviations from age expected normal values. Further, the QEEG profile of brain dysfunction seen in these children was extremely similar to that previously reported in a large population of crack cocaine dependent adults. These abnormalities were characterized by significant excess of relative power in the alpha frequency band, and deficits of absolute and relative power in the delta and theta bands. Characteristic disturbances in interhemispheric relationships were also present. The similarities between the QEEG profiles of those adults with chronic exposure and children with prenatal exposure suggests that the brain dysfunction reflected in the QEEG is not a result of a transient change in neurotransmission, but a more profound alteration which persists in these children at school age. Further study is required to extend these findings to a larger group of children, and to investigate the potential relationship between these neurophysiological abnormalities and the developmental, behavioral and co-morbid features observed in such children.

Adult↗

PubMed1994

Diminished cerebral metabolic response to motor stimulation in schizophrenics: a PET study.

Positron emission tomography (PET) and the deoxyglucose method were used to measure cerebral metabolism in 14 normals and 13 schizophrenics at rest and during performance of simple and complex finger-movement sequences. The normals, but not the schizophrenics, showed significant metabolic activation in mesial frontal and contralateral sensorimotor and premotor regions during the complex movement. The relative metabolism of schizophrenics was significantly lower than normal in frontal regions and higher than normal in thalamus and basal ganglia under all scanning conditions. The results suggest that schizophrenics may have a brain dysfunction which limits their capacity to produce a focal metabolic response to stimulation in several functionally distinct brain regions.

Adult↗

PubMed1994

Nonepileptic seizures.

A review of the literature on epileptic seizures (NES) is presented, a common clinical entity that can be reliably diagnosed if suggestion and video-EEG monitoring are combined with an appreciation of the phenomenology of epileptic and nonepileptic events. Axis I psychiatric disorders with symptoms such as anxiety or dissociation should be considered in the differential diagnosis of NES.

Comorbidity↗

PubMed1993

Nonepileptic seizures during apparent sleep.

We report 12 patients with nonepileptic seizures (NESs) documented with video-electroencephalographic monitoring during apparent sleep. There were 7 females and 5 males, ages 11 to 67 years (mean, 33 yr). In all patients there was a well-organized posterior alpha rhythm present immediately before onset of clinical changes despite the appearance of sleep. Patients later "confirmed" that these attacks occurred during sleep. Features of these episodes were typical of NESs and none were associated with ictal or postictal electroencephalographic changes other than muscle and movement artifact. Provocative testing with suggestion confirmed the nonepileptic nature of these episodes in 9 patients. Three patients had epileptiform discharges during prolonged interictal recordings and 1 had a documented complex partial seizure. Our findings indicate that reports of seizures during sleep are not uncommon among patients with NESs.

Adolescent↗

PubMed1993

Treatment resistant depression in a case of minor head injury: an electrophysiological hypothesis.

A relatively small but highly concordant literature suggests that manic depressive psychoses may include familial as well as nonfamilial subtypes. The latter, which appears to be an acquired form, follows brain injury of various etiology, displays EEG abnormalities and tends to respond well to anticonvulsant therapy. In this study we postulate an extension of this dichotomy to a larger spectrum of affective disorder, including milder but "treatment resistant" forms often associated with a high degree of dysfunction. Central to this hypothesis is information gathered from the longitudinal study of a well defined case in which precise clinical and electrophysiological data have been obtained at critical junctures. This data also leads us to suggest the existence of a latent vulnerability to psychosocial stressors in a subgroup of minor head injured patients. Once triggered, the resulting psychopathological state may be clinically indistinguishable from similar but etiologically distinct conditions. However, they respond poorly, if at all, to the treatments usually effective for mood disorders, often causing puzzlement and frustration among clinicians as well as mounting hopelessness in patients. This organic mood disorder subtype, which can be described as "neuro-sensitization mood disorder," may be identified by combining a thorough history, including perinatal events and putative brain injury, with electrophysiological data consisting of quantitative EEG (QEEG) in association with evoked potentials. In cases with positive findings, anticonvulsants such as carbamazepine, clonazepam and valproic acid can be a treatment of choice.

Adult↗