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Biomedical subjects

M W Berfelo

Publications and source records attributed to M W Berfelo.

12 recordsLinked to original sources
PubMed2005

Vagus nerve stimulation in patients with catastrophic childhood epilepsy, a 2-year follow-up study.

PURPOSE: To establish the long-term efficacy and tolerability of vagus nerve stimulation (VNS) in children with a Lennox-like syndrome. METHOD: This study was a longitudinal observational prospective cohort analysis. Baseline: 6 months. FOLLOW-UP: 24 months. Screening (baseline and every 6 months): MRI (baseline only), EEG, neuropsychological evaluation, ECG and blood sampling for antiepileptic drug levels. Nineteen children are included. RESULTS: A seizure frequency reduction of 20.6% was found at the end of the follow-up period. No relationship was detected between the length of the stimulation period and the reduction in the seizure frequency. 21% of the patients showed a reduction in seizure frequency of 50% or more. The seizure severity showed improvement in the first 12 months of treatment. The largest seizure reduction was found in the patients with highest frequency of background activity at the baseline EEG. Neuropsychological findings: no negative impact on behaviour, moderate improvement in function, behaviour and mood. Largest seizure reduction was found in the group with the highest baseline mental function. The scores for mental age improved independently of the seizure control. Twelve patients (63%) experienced minor side effects, which subsided after 1 month. CONCLUSION: (1) There was a significant reduction in seizure frequency and severity. (2) No serious side effects were recorded. (3) No negative effects on cognition or quality of life were apparent. (4) Patients with highest baseline mental functioning showed the highest seizure reduction. (5) Those patients with less disturbed EEG (high background activity and less interictal epileptic activity) showed the highest seizure reduction.

Adolescent↗
PubMed2003

Effectiveness of behavioral graded activity after first-time lumbar disc surgery: short term results of a randomized controlled trial.

Behavioral approaches to treating patients following lumbar disc surgery are becoming increasingly popular. The treatment method is based on the assumption that pain and pain disability are not only influenced by somatic pathology, if found, but also by psychological and social factors. A recent study highlighted the effectiveness of cognitive-behavioral interventions, as compared to no treatment, for chronic low back patients. However, to the authors' knowledge, there is no randomized controlled trial that evaluates a behavioral program for patients following lumbar disc surgery. The purpose of this study was to assess the effectiveness of a behavioral graded activity (BGA) program compared to usual care (UC) in physiotherapy following first-time lumbar disc surgery. The BGA program was a patient-tailored intervention based upon operant therapy. The essence of the BGA is to teach patients that it is safe to increase activity levels. The study was designed as a randomized controlled trial. Assessments were carried out before and after treatment by an observer blinded to treatment allocation. Patients suffering residual symptoms restricting their activities of daily living and/or work at the 6 weeks post-surgery consultation by the neurosurgeon were included. The exclusion criteria were: complications during surgery, any relevant underlying pathology, and any contraindication to physiotherapy or the BGA program. Primary outcome measures were the patient's Global Perceived Effect and the functional status. Secondary measures were: fear of movement, viewing pain as extremely threatening, pain, severity of the main complaint, range of motion, and relapses. Physiotherapists in the BGA group received proper training. Between November 1997 and December 1999, 105 patients were randomized; 53 into the UC group and 52 into the BGA group. The unadjusted analysis shows a 19.3% (95% CI: 0.1 to 38.5) statistically significant difference to the advantage of the UC group on Global Perceived Effect. This result, however, is not robust, as the adjusted analyses reveal a difference of 15.7% (95% CI: -3.9 to 35.2), which is not statistically significant. For all other outcome measures there were no statistically significant or clinically relevant differences between the two intervention groups. In general, the physiotherapists' compliance with the BGA program was satisfactory, although not all treatments, either in the BGA or the UC group, were delivered exactly as planned, resulting in less contrast between the two interventions than had been planned for. There was one re-operation in each group. The BGA program was not more effective than UC in patients following first-time lumbar disc surgery. For Global Perceived Effect there was a borderline statistically significant difference to the advantage of the UC group. On functional status and all other outcome measures there were no relevant differences between interventions. The number of re-operations was negligible, indicating that it is safe to exercise after first-time disc surgery.

Adolescent↗
PubMed2001

Effects of 6 months of treatment with vagus nerve stimulation on behavior in children with lennox-gastaut syndrome in an open clinical and nonrandomized study.

The effect of vagus nerve stimulation (VNS) on behavior outcomes was studied in 16 children with Lennox-Gastaut syndrome. We used the following stimulation parameters: output current, 11 2 to 2 mA; signal frequency, 30 Hz; signal pulse width, 500 microseconds; signal on and off times, 30 seconds on and 3 minutes off. The test battery consisted of cognitive tests measuring mental age, attention, language, psychomotor function, and cognitive style, and quality-of-life measurements assessing independence, behavioral problems, symptoms of pervasive development disorders (PDDs) and mood. The results show relatively small changes in behavioral outcomes concurrently with modest effects on seizure frequency (an average of 26.9% seizure reduction). When baseline and endpoint measurements are compared none of the cognitive measures show any deterioration and three of five cognitive measures show slight positive changes. Among the quality-of-life measures, one measure showed a slight worsening of scores and three showed slight improvement. When the group is divided into subgroups on the basis of treatment effect the most prominent improvements are observed in the group without any effects of VNS on seizure frequency. These patients gained, on average, 9.5 months in mental age and showed more independent behavior, mood improvements and fewer PDD symptoms. This suggests an effect of VNS on behavioral function independent of changes in seizure frequency.

Journal Article↗
PubMed2001

Vagus nerve stimulation in children with therapy-resistant epilepsy diagnosed as Lennox-Gastaut syndrome: clinical results, neuropsychological effects, and cost-effectiveness.

We studied the clinical efficacy and tolerability, neuropsychological effects, and cost-effectiveness (direct medical costs, direct nonmedical costs, and indirect costs) of vagus nerve stimulation (VNS) in children with Lennox-like syndrome (n = 16). The situation 6 months before implantation of the device is compared with that 6 months after surgery. Seizure frequency and severity are significantly reduced during VNS: 25% of the patients show a reduction in seizure frequency of 50% or greater; overall seizure reduction is 26.9%. Measures of neuropsychological outcome show a moderate improvement in mental functioning, behavior, and mood. The scores for mood and mental age improve independently of seizure control. Side effects are minor and transient. There is a significant reduction in direct non-health care costs, ergotherapy, and the number of days of sub-optimal functioning of the child. The costs during the 6 postoperative months are 2,876.06 Euros less than the costs during the 6 months before VNS; the payback period is 2.3 years.

Adolescent↗
PubMed2000

Behavioral-graded activity compared with usual care after first-time disk surgery: considerations of the design of a randomized clinical trial.

OBJECTIVE: To present the design of a trial on the effectiveness of a behavioral-graded activity model. DESIGN: Randomized clinical trial. PATIENTS: Patients undergoing first-time lumbar disk surgery who still have low-back pain at the 6-week neurosurgical consultation. INTERVENTIONS: A patient-tailored behavioral-graded activity program that is based on operant therapy. The key elements of this program are baseline measurements, goal-setting, and time-contingency. This program is compared with usual care in physiotherapy, which is pain-contingent. OUTCOME MEASURES: Primary measures are the patient's global impression of the effect and their functional status. Secondary measures are kinesiophobia, catastrophizing, pain, main complaint, range of motion, and relapses. The direct and indirect costs will also be assessed. The effect measures are rated before randomization and 3, 6, and 12 months later. DISCUSSION: Several trials have been conducted on the effectiveness of behavioral treatments. Subjects were always patients with chronic low-back pain. In this trial, we apply such a treatment in patients after first-time disk surgery in a primary care setting.

Adaptation, Psychological↗
PubMed1993

A unique case of intracranial metastasis from lung carcinoma.

We describe a case of an intracranial metastasis from a lung carcinoma in the same location from which an intracranial meningioma had been completely removed surgically eleven months earlier. It is demonstrated that the metastasis originated in the scar of the first operation.

Brain↗
PubMed1990

Computed tomography-guided and stereotactic techniques in the diagnosis and treatment of cerebral tuberculoma.

The advantages of computed tomography-guided preoperative localization of brain lesions are illustrated in four cases of solitary tuberculoma and in one case of tuberculous abscess of both the cerebrum and the cerebellum. The role of stereotactic diagnostic techniques is emphasized. The clinical presentation and the computed tomography findings in these patients were equivalent to those from glial or metastatic tumors. Synchronous pulmonary tuberculosis was not present in these patients, but in three patients there was metachronous tuberculosis. Tuberculous meningitis had not developed in any of the patients.

Adult↗
PubMed1989

Chemonucleolysis versus discectomy: a randomized multicenter trial.

A randomized clinical trial was carried out to compare the results of open discectomy with those of chemonucleolysis in 151 patients suffering from a disc herniation at L4-5 or L5-S1. All patients fulfilled strict entry criteria; 78 patients underwent open discectomy and 73 were subjected to chemonucleolysis. An increase in radicular pain immediately after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the discectomy group. The efficacy of discectomy appeared to be definitely superior to that of chemonucleolysis. Within a follow-up period of 1 year, 18 patients (25%) required open discectomy following failed chemonucleolysis; two patients (3%) in the discectomy group needed a second operation. Open discectomy following previous chemonucleolysis was successful in only 44% of cases. Comparison of the final results of the two modes of treatment 12 months after the last intervention (including second treatment) did not reveal any significant differences. The duration of the preoperative symptoms, the level of disc herniation, and the leakage of contrast medium out of the disc appeared to be of no relevance to the final outcome. The complication rates in both treatment groups were low.

Adolescent↗
PubMed1988

Chemonucleolysis or discectomy? Results of a randomized multicentre trial in patients with a herniated lumbar intervertebral disc (a preliminary report).

A randomized trial was carried out to compare the results of discectomy and chemonucleolysis in 151 patients, suffering from lumbar disc herniation L4-L5 or L5-S1. All patients fulfilled strict entry criteria. Seventy eight patients underwent surgical discectomy, 73 were treated with chemonucleolysis. Within one year of follow-up 18 patients (25%) required surgery after chemonucleolysis, whereas 2 patients (3%) in the surgery group underwent re-operation. Increase of radicular pain within 30 days after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the surgery group. The results of open surgery after preceding chemonucleolysis was successful in 44% and unsuccessful in 56%. The final result of chemonucleolysis, including second treatment, was still slightly less favourable (73%) the result of primary surgery (79%).

Adolescent↗
PubMed1982

The Rotterdam teletransducer. A telemetric device for measuring epidural pressure.

A discussion on the clinical value of telemetric measurements of intracranial pressure is presented. The technical improvements of an earlier described implantable epidural transducer are reported. Furthermore, the results are given of an in vivo study in dogs of the relation between epidural pressure as measured by this device and ventricular fluid pressure for variable physiologic conditions. An evaluation of the implantation technique is included and a justification for the selection of the constituting materials is given. Clinical results obtained in a patient are illustrated.

Animals↗