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Biomedical subjects

P F Bladin

Publications and source records attributed to P F Bladin.

At least 19 recordsLinked to original sources
PubMed2001

The longitudinal course of adjustment after seizure surgery.

Surgical alleviation of chronic epilepsy can give rise to a process of adjustment as the chronically ill patient learns to become well. This process can manifest clinically as an array of symptoms which we have previously described as the 'burden of normality'. The aim of this study was to explore the longitudinal course of post-operative adjustment by mapping the incidence of symptoms of the burden of normality over a period of 2 years, and examining symptom occurrence relative to seizure outcome. A series of 90 anterior temporal lobectomy (ATL) patients was drawn from our Seizure Surgery Follow-up and Rehabilitation Program. All patients were prospectively assessed using the Austin CEP Interview, which covers symptoms of the burden of normality. In total, 66% of patients reported symptoms at some time within the first 2 years of surgery. Symptoms often emerged by the 3 month review, but were still seen frequently in the second year. At the 24 month review, patients who had been seizure free or experienced auras only within the previous 18 months were significantly more likely to report symptoms compared to patients who had experienced complex partial and/or generalized tonic-clonic seizures (P = 0.03). Surgical alleviation of seizures in chronic epilepsy brings with it the burden of normality. Recognition of this syndrome is essential in maximizing patient outcome.

Adult↗
PubMed2000

Historical note: "the epileptic constitution": the psychoanalytic concept of epilepsy.

The rise of the psychoanalytic approach to behavioral medicine in the early part of the 20th century created a unique concept of the nature and the aetiology of epilepsy based upon dynamic psychopathology. As a direct result of this a radical change in both medical and community perception of this condition was generated, and this was to persist up to and beyond the mid-century mark. This historical note details the adoption, and the rise and fall of this concept of "the epileptic constitution", and a consideration of the negative effects that flowed from this, permeating all areas of psychiatry, neurology and even the criminal justice system.

Combat Disorders↗
PubMed2000

Narcolepsy -- cataplexy and psychoanalytic theory of sleep and dreams.

Narcolepsy had been documented some twenty years before the psychoanalytic movement, emphasizing the central role of sleep and dreams in the understanding of mental health, offered an entirely novel theory of its aetiology. And when the full range of the behavioral aspects of the condition were documented, it was obvious that intense psychoanalytic interest in it was inevitable. Unfortunately, even mainstream neurology, lacking any rival physiological explanation, for a time tended to entertain a definite role for such beliefs, at least in some cases. However, such a theory involving outre concepts of repressed, guilt-ridden sexual drives as an explanation of the behavioral aspects of narcolepsy-cataplexy, of necessity simply added to the burdens of the sufferer. For it became clear that the condition by itself produced enough psycho-social problems without further adding to them. This historical note details the persistence of this misconceived theory up to the later decades of this century, and the burden that it placed upon those who suffered from this condition.

Cataplexy↗
PubMed1999

Outcome of temporal lobectomy: expectations and the prediction of perceived success.

PURPOSE: This study examined the independent contributions of medical and psychosocial factors to perceived surgical success. We aimed to develop a multidimensional model predictive of perceived surgical outcome. METHODS: Fifty anterior temporal lobectomy (ATL) patients were prospectively assessed, using a formally coded, semistructured clinical interview. This has been routinely administered pre- and post-operatively as part of a larger, nationwide study of Australian ATL patients. The interview covers a broad range of epileptological, psychiatric, neuropsychological and psychosocial issues. Variables from these domains were examined in relation to the patient's perception of surgical success at the 6-month post-operative review. RESULTS: Variables that correlated with success were analysed using principal components analysis and multiple regression. A predictive model of perceived surgical success emerged, which highlighted the multidimensionality of outcome. Independent effects were observed for both medical and psychosocial factors. These included the patients' pre-operative expectations of surgery, their post-operative seizure outcome, and affective state. The findings also highlighted the importance of discarding sick role behaviours associated with chronic epilepsy, after surgery. CONCLUSIONS: Traditional outcome measures (seizure frequency, post-operative affect) are significant in the patient's evaluation of surgical success. These traditional measures, however, do not account for the process of psychosocial adjustment surrounding seizure surgery. This process involves two major components: (1) positive anticipation of change prior to surgery, and (2) learning to discard roles associated with chronic epilepsy after surgery.

Adult↗
PubMed1999

Patient readmission and support utilization following anterior temporal lobectomy.

The aim of this study was to examine factors precipitating patient readmission, following anterior temporal lobectomy (ATL) for refractory epilepsy. A second aim was to explore the use of hospital outpatient and community support services ('outpatient services') by this patient population. These aims served the more general goal of identifying patients most likely in need of services additional to those routinely provided by our Seizure Surgery Follow-up and Rehabilitation Programme. The medical records of 100 consecutive ATL patients were retrospectively examined for the incidence and diagnoses precipitating acute readmission, and the utilization of additional outpatient services. Twenty-one patients (21%) required readmission post-ATL, totalling 47 readmissions between them. Psychiatric diagnoses were the most prevalent (53%), including anxiety, depression and/or post-ictal psychosis. Epileptological diagnoses were the other main precipitant (28%). Additional outpatient services were predominantly utilized for ongoing psychological support. Of the 21 patients requiring readmission, 10(10%) also needed additional outpatient services. These patients were predominantly female or unemployed, in contrast to male or employed patients who tended to require readmission only. Seventeen patients (17%) were maintained within the community using additional outpatient services only. Characteristics of these patients included disrupted family dynamics, limited social networks, and/or a psychiatric history. These patients were also more frequently beyond the 24-month follow-up period of the programme. A profile of patients most in need of additional support services can be constructed to assist team planning of proactive management strategies for the rehabilitation phase of ATL.

Acute Disease↗
PubMed1998

Patient expectations of temporal lobe surgery.

PURPOSE: The purpose of this study was to examine expectations of postoperative quality of life expressed by patients undergoing anterior temporal lobectomy (ATL) for the control of intractable seizures. An important component of this study was an exploration of the relationship between preoperative expectations and perceived success of the operation. METHODS: Psychosocial functioning of 60 patients was assessed pre- and postoperatively, using a standardised, semistructured clinical interview. Preoperative assessment included a detailed examination of the patients' expectations of surgery, while postoperative assessment at 6 months examined the patients' perception of surgical success with respect to seizure outcome and postoperative psychosocial status. RESULTS: A range of expectations were expressed about postoperative outcome. These were classified into 11 posthoc categories. Patients who perceived the operation as a success tended to endorse 'practical' expectations (i.e., driving, employment, activities) preoperatively, rather than expectations of a psychologic or social nature (i.e., self-change, relationships). These patients experienced fewer postoperative seizures and psychosocial difficulties. In contrast, a perceived lack of success was associated with greater emphasis on psychosocial expectations preoperatively. These patients experienced a greater number of perceived postoperative psychosocial difficulties, and more postoperative seizures. CONCLUSIONS: Preoperative expectations of surgery formed an important baseline against which to assess postoperative outcome, and should constitute a routine part of assessment in studies of psychosocial outcome of ATL.

Adaptation, Psychological↗
PubMed1998

History of "epileptic vertigo": its medical, social, and forensic problems.

We traced the history of the association of vertigo with the condition of epilepsy through the ages. In ancient times, vertigo was closely linked with epilepsy; indeed, it was believed to be the harbinger of chronic seizures. With the advent of modern scientific study of epilepsy initiated by the French in the 18th and 19th centuries, vertigo, not yet associated with disease of the inner ear or vestibular connections, assumed a specific role in the clinical gradation of seizure entities. It was believed to be the mildest form of epilepsy. Later, with the establishment of the conceptual linkage of "larval" or "masked" epilepsy with outbursts of violence, "epileptic vertigo" was considered the trigger for potentially lethal behavior and thus assumed a much-feared reputation. Evidence for this abounds in the medical, legal, and even the popular literature at the end of the 19th century. The role of vertigo and its epileptic associations occupied the attention of most of the pioneer workers in epileptology of that era, and it was finally agreed that as a symptom the inner ear rather than epilepsy underlay its causation. Even today, epilepsy and vertigo are conceptually associated, sometimes erroneously.

Epilepsy↗
PubMed1997

Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome.

OBJECTIVES: To study the ictal phenomenology, aetiology, and outcome of convulsions occurring within seconds of impact in violent collision sport. DESIGN: Retrospective identification of convulsions associated with concussive brain injury from case records from medical officers of football clubs over a 15 year period. SUBJECTS: Elite Australian rules and rugby league footballers. MAIN OUTCOME MEASURES: Neuroimaging studies, electroencephalography, neuropsychological test data, and statistics on performance in matches to determine presence of structural or functional brain injury. Clinical follow up and electroencephalography for evidence of epilepsy. RESULTS: Twenty two cases of concussive convulsions were identified with four events documented on television videotape. Convulsions began within 2 seconds of impact and comprised an initial period of tonic stiffening followed by myoclonic jerks of all limbs lasting up to 150 seconds. Some asymmetry in the convulsive manifestations was common, and recovery of consciousness was rapid. No structural or permanent brain injury was present on clinical assessment, neuropsychological testing, or neuroimaging studies. All players returned to elite competition within two weeks of the incident. Epilepsy did not develop in any player over a mean (range) follow up of 3.5 (1-13) years. CONCLUSIONS: These concussive or impact convulsions are probably a non-epileptic phenomenon, somewhat akin to convulsive syncope. The mechanism may be a transient traumatic functional decerebration. In concussive convulsions the outcome is universally good, antiepileptic treatment is not indicated, and prolonged absence from sport is unwarranted.

Adult↗
PubMed1997

Perfusion patterns during temporal lobe seizures: relationship to surgical outcome.

We sought to determine whether patterns of ictal hyperfusion demonstrated using [99mTC]HMPAO (hexamethylpropylene amine oxime) single photon emission computed tomography (SPECT) predict outcome of temporal lobectomy; in particular, whether the more extensive patterns of ictal hyperperfusion are associated with poor outcome. We studied 63 patients who had ictal SPECT studies prior to temporal lobectomy. Hyperperfusion on ictal SPECT scans was lateralized, and classified into: (i) 'typical', (ii) 'typical with posterior extension', (iii) 'bilateral' and (iv) 'atypical' patterns. Outcome (minimum of 2 years follow-up) was classified as either seizure free, or not seizure free. Actuarial analysis was used to test the relationship of SPECT patterns with outcome. There were 35 cases with the typical ictal SPECT pattern, 13 posterior, nine bilateral and six atypical cases. The atypical pattern was associated with lack of pathology in the surgical specimen. Outcome was similar for the typical, posterior and bilateral with 60%, 69% and 67% seizure free, respectively. In contrast, the atypical group had a worse outcome with only 33% seizure free. Actuarial analysis showed a significant difference in outcome between patients with the typical pattern, and patients with the atypical pattern (P = 0.04). We conclude that extended patterns of ictal perfusion in temporal lobe epilepsy do not predict poor outcome, indicating that extended hyperperfusion probably represents seizure propagation pathways rather than intrinsically epileptogenic tissue. Atypical patterns of hyperperfusion are associated with poor outcome and may indicate diffuse or extra-temporal epileptogenicity.

Actuarial Analysis↗
PubMed1996

Does naming contribute to memory self-report in temporal lobe epilepsy?

The present study evaluated the hypothesis (Mayeux et al., 1980) that visual confrontation naming deficits may underlie the memory complaint in patients with temporal lobe epilepsy (TLE). Thirty-nine patients with medically refractory left (n = 23) and right (n = 16) TLE were compared with an epilepsy control group with idiopathic primary generalized epilepsy (n = 38). All subjects completed selected subtests of the Multilingual Aphasia Examination and Wechsler Memory Scale (Form 1) together with a measure specifically designed for quantification of the memory complaint in TLE. Objective verbal memory test performance, confrontation naming, repetition, and comprehension were unrelated to memory self-report. Controlled Oral Word Association was the only measure to exert an influence on memory self-ratings, and this relationship was specific to the TLE group. The hypothesis of Mayeux et al. (1980) was not specifically supported, but the present findings do suggest that cognitive processes reflected in orthographically based and internally generated word retrieval play a role in memory self-report.

Adult↗
PubMed1996

Temporal lobe epilepsy subtypes: differential patterns of cerebral perfusion on ictal SPECT.

PURPOSE: We studied cerebral perfusion patterns in the various subtypes of TLE, as determined by pathology and good outcome after temporal lobectomy (as confirmation of temporal origin). METHODS: We studied clinical features and ictal technetium 99m hexamethyl-propyleneamineoxime (99mTc-HM-PAO) single-photon emission-computed tomography (SPECT) in four subgroups of patients with intractable temporal lobe epilepsy (TLE) treated with surgery: hippocampal sclerosis (group 1, n = 10), foreign-tissue lesion in mesial temporal lobe (group 2, n = 8), foreign-tissue lesion in lateral temporal lobe (group 3, n = 7), and normal temporal lobe tissue with good surgical outcome (group 4, n = 5). RESULTS: No major clinical differences in auras, complex partial seizures or postictal states were identified among the groups. Ictal SPECT showed distinct patterns of cerebral perfusion in these subtypes of TLE. In groups 1 and 2, hyperperfusion was seen in the ipsilateral mesial and lateral temporal regions. In group 3, hyperperfusion was seen bilaterally in the temporal lobes with predominant changes in the region of the lesion. Hyperperfusion was restricted to the ipsilateral anteromesial temporal region in group 4. Ipsilateral temporal hyperperfusion in mesial onset seizures can be explained by known anatomic projections between mesial structures and ipsilateral temporal neocortex. Bilateral temporal hyperperfusion in lateral onset seizures can be explained by the presence of anterior commissural connections between lateral temporal neocortex and the contralateral amygdala. CONCLUSIONS: We conclude that the perfusion patterns seen on ictal SPECT are helpful for subclassification of temporal lobe seizures, whereas clinical features are relatively unhelpful. These perfusion patterns provide an insight into preferential pathways of seizure propagation in the subtypes of TLE.

Adolescent↗
PubMed1995

SPECT in the localisation of extratemporal and temporal seizure foci.

The yield of ictal, postictal, and interictal SPECT was compared in the localisation of seizure foci in 177 patients with partial epilepsy. In 119 patients with known unilateral temporal lobe epilepsy ictal SPECT (97% correct localisation) was superior to postictal SPECT (71% correct), which was better than interictal studies (48% correct). Similarly, in cases of known or suspected extratemporal epilepsy the yield of ictal SPECT studies was high (92%). By contrast, the yield of postictal studies was much lower (46%) and usually only very early postictal studies were diagnostic. Interictal SPECT was of little value. The accuracy of ictal SPECT in localising temporal lobe seizures is now well established. Extratemporal seizures are often brief and difficult to localise. This report shows that ictal SPECT also has a high diagnostic yield in a wide range of extratemporal epilepsies. The brevity of many extratemporal seizures means that true ictal SPECT examinations can be difficult to achieve, but the high diagnostic yield justifies the special organisational effort needed to obtain such studies.

Epilepsies, Partial↗
PubMed1995

Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis.

We used actuarial methods to study outcome after temporal lobectomy in 135 consecutive patients classified into subgroups according to preoperative MRI findings. Sixty months after surgery, 69% of patients with foreign tissue lesions, 50% with hippocampal sclerosis, and 21% with normal MRIs had no postoperative seizures. An eventual seizure-free state of 2 years or more, whether the patient was seizure-free since surgery or not, was achieved by 80% of patients with foreign tissue lesions, 62% of those with hippocampal sclerosis, and 36% of those with normal MRIs. Outcome was worse in those with normal MRIs than in the other two groups. Early postoperative seizures with later remission (the "running down" phenomenon) occurred in all groups. Late seizure recurrence was present only in the hippocampal sclerosis group. These data show that preoperative MRI is a useful predictor of outcome and that actuarial analysis provides insight into different longitudinal patterns of outcome in MRI subgroups. This information can now be used in preoperative counseling.

Actuarial Analysis↗
PubMed1994

Ictal postictal and interictal single-photon emission tomography in the lateralization of temporal lobe epilepsy.

Single-photon emission tomography (SPET) using radioligands that are fixed on first pass through the cerebral circulation shows distinctive and rapidly changing blood flow patterns accompanying temporal lobe seizures. We sought to determine the optimal time to perform SPET studies for clinical seizure lateralization in temporal lobe epilepsy. Interictal, ictal and postictal SPET scans of 73 consecutively studied patients with unilateral temporal lobe epilepsy were read by three blinded observers to assess the accuracy of lateralization in each condition. The blinded observers correctly identified the side of focus in 97% of ictal studies, 72% of postictal studies and 50% of interictal studies. No incorrect scores were made in the ictal studies, whilst 5% of postictal and 12% of interictal studies were lateralized to the wrong side. Inter-observer agreement was best with the ictal studies. The dramatic perfusion changes of ictal SPET provide consistent, reliable and easily interpretable information that is superior to that provided by interictal and postictal studies. Injection of ligand during seizures is therefore the method of choice for SPET to aid the non-invasive lateralization of temporal seizure foci.

Adult↗
PubMed1994

P3 latency jitter assessed using 2 techniques. I. Simulated data and surface recordings in normal subjects.

Latency variability measurement using cross-correlational techniques has the drawback of alignment to background noise not related to ERP activity. We compared latency jitter estimation in simulated and real P3 recordings using Woody's algorithm and a non-cross-correlational technique, the maximum likelihood technique (MLT). Simulated ERPs (with introduced latency jitter) were generated using either a 1/2 cycle 2 Hz sine wave or an averaged P3 ERP with 1 of 3 added noise types in 5 signal to noise ratios (SNRs): (i) white noise; (ii) a 10 Hz sine wave; (iii) a 7.5 Hz sine wave. Jitter measurement accuracy was assessed using mean square error (MSE) for 1 iteration of the Woody method and each of 4 iterations of the MLT. Lowest MSEs occurred for higher SNRs and 1 iteration of the MLT. The MLT and Woody method were applied to P3 ERPs of 13 subjects with SNRs greater than 0.4 P3 latency jitter was significantly lower for the MLT. Latency jitter (both methods) did not differ between homologous electrodes and was highest in posterior electrodes. In the latency corrected ERP data of subjects with persistent alpha activity periodic components occurred in the Woody corrected average (not seen in the conventional or the MLT corrected averages). Our data indicate that the MLT is the more accurate method for determining latency jitter.

Adult↗
PubMed1994

P3 latency jitter assessed using 2 techniques. II. Surface and sphenoidal recordings in subjects with focal epilepsy.

We compared the latency variability in auditory P3s of 13 subjects with unilateral temporal lobe epilepsy (TLE) to that of normal controls. We predicted that increased latency jitter would occur in TLE subjects, particularly on the epileptic side. ERPs were recorded from scalp and sphenoidal sites relative to a balanced non-cephalic reference. Signal-to-noise ratios (SNRs) were calculated for each subject. Data were excluded if SNRs fell below 0.4. P3 latency jitter was estimated using 2 methods: Woody's algorithm and the maximum likelihood technique (MLT), a novel method of jitter assessment. SNRs were significantly higher in controls and were maximal posteriorly for both groups. P3 peak amplitude was significantly smaller in TLE subjects at temporal sites. Latency jitter (MLT method) was greatest in posterior sites and mirrored the jitter profiles of controls. Latency jitter was significantly higher in TLE subjects in bilateral frontal and temporal sites, but was not higher on the side of the focus and could not be attributed to lower SNRs. The increased bilateral latency jitter in these patients may be related to effects of anticonvulsants or the more extensive nature of the underlying epileptic disorder.

Adolescent↗