PubMed Health⌕ Search

Biomedical subjects

W Fröscher

Publications and source records attributed to W Fröscher.

At least 19 recordsLinked to original sources
PubMed2004

[On the value of neuropsychological short tests in epileptology].

Cognitive deficits are common in patients with epilepsy refractive to therapy and have considerable influence on the quality of life in this group of patients. Therefore, neuropsychological investigations should play an important role in the comprehensive evaluation of patients with chronic epilepsy. The aim of this study was to examine whether a reliable screening for cognitive deficits in these patients may be reduced to the assessment of two bedside tests. In a prospective study we analyzed the results of 40 patients with epilepsy refractive to therapy subjected to a 45-min neuropsychological screening battery and compared them with the results of a short battery consisting of two bedside tests. Using the screening battery as the gold standard, the short battery had a sensitivity of 50% and a specificity of 100%. Changing the criteria for pathological results in the short battery, sensitivity could be raised to 81.25% but specificity fell to 50%. Therefore, bedside tests instead of longer neuropsychological testing cannot be recommended as a screening method for cognitive deficits in patients with chronic epilepsy.

Adult↗
PubMed2001

Modification of slow cortical potentials in patients with refractory epilepsy: a controlled outcome study.

PURPOSE: To compare self-regulation of low-frequency EEG components (slow cortical potentials, SCPs) with other methods of seizure control for patients with drug-refractory partial epilepsy and to separate the real anticonvulsive effect from placebo effects. METHODS: Results of a treatment program of SCP self-regulation (experimental group) are compared with two groups of patients, one of which learned self-control of respiratory parameters (end-tidal CO2 and respiration rate: RES group); the other received medication with new anticonvulsive drugs (AEDs) in combination with psychosocial counseling (MED group). Clinical, cognitive, behavioral, and personality measures were assessed before and after treatment. In addition, to control for placebo responses, patients repeatedly estimated their beliefs in the efficiency of the respective treatment, their satisfaction and expectations, and the quality of the relationship with their therapists. RESULTS: SCP and MED groups showed a significant decrease of seizure frequency, but the RES group did not. Clear positive changes in the sociopsychological adjustment were obtained in all three groups, with the maximal improvement being attained in the RES group. CONCLUSIONS: All kinds of therapy result in considerable improvement of patients' emotional state, which may in part be due to potential placebo effects: however, this improvement is not related to the quality of the therapeutic effect proper (i.e., seizure reduction). Traditional double-blind control group designs are inappropriate for behavioral interventions or treatments with psychoactive pharmacologic drugs. Rather, specific tests can be developed to control the placebo effect and to separate it from the genuine therapeutic effects.

Adolescent↗
PubMed2001

Biofeedback treatment in patients with refractory epilepsy: changes in depression and control orientation.

Depression is a common and serious interictal problem in patients with epilepsy. The genesis of depressive disorders is multifactorial. One aetiological aspect focuses on psychosocial factors. It was hypothesized that uncontrollable, unpredictable chronic aversive events (i.e. epileptic seizures) result in cognitive deficits of external control orientation. If this is true, biofeedback training could represent a possible treatment strategy to lower depression, because biofeedback is known to mediate success experiences and control. Measures of depression and locus of control were administered to 20 patients with refractory partial epilepsy before and after biofeedback treatment. The biofeedback consisted of slow cortical potentials or breathing parameters in 10 patients each. A clear relationship occurred between depression and locus of control in the subjects. After biofeedback training control orientation moved towards a more internal locus of control. Also, depression scores were significantly reduced six months after training. Results show that in patients with refractory epilepsy depression is highly correlated with locus of control, in a way that external control orientation relates to high depression scores. Biofeedback is able to improve internal control orientation through personal success mediation.

Adult↗
PubMed2001

Treatment of pathological crying with citalopram.

Pathological laughing and/or crying may occur as a concomitant symptom of various diseases of the central nervous system. No known anatomical basis for any of these disorders exists at present. However, references to a disturbance in central serotoninergic neurotransmission have become frequent in the literature, implicating this as an important etiological factor. In the present communication three cases of successful treatment of pathological crying using the SSRI citalopram are reported. Besides the response of pathological crying in cerebral ischemia to SSRIs, which has already been described in earlier publications, this is the first report on the successful administration of citalopram for treating pathological crying in Parkinson's disease. Onset of response was very rapid in all cases.

Aged↗
PubMed2000

[Drug therapy before and after surgery for epilepsy. Critical review and recommendations].

As a result of a critical review of the literature and a survey at German epilepsy centers of usual pre- and postoperative drug treatment, the following strategy is recommended: 1. Patients under consideration for surgery should be referred to specialists. Experience has shown that surgery is reasonable for only about a third of all patients with refractory epilepsies. The patient should first have been treated for at least 3 years with at least two first-line drugs in monotherapy and subsequent combined therapy. This applies only to medial temporal lobe epilepsies with very good postoperative prognoses. All other surgically removable epilepsy syndromes with less positive prognosis should be treated with additional antiepileptic drugs before any surgery. 2. There is no exception to the continuation of drug treatment after epilepsy surgery. If the patient remains free of seizures for at least 2 years, discontinuing the drug treatment can be discussed, just as with patients who are free of seizures due to drug treatment alone. In general, the less successful the operative therapy, the longer and more intensive the drug treatment.

Adult↗
PubMed1999

[Serum concentration of anticonvulsants. Practical guidelines for measuring and useful interpretation. Therapy Committee of the German Section of the International Epilepsy League].

The clinical relevance of being informed on the serum concentration of antiepileptic drugs has been judged very differently during the last decades. Therefore the Commission on the treatment of epilepsy (German section of the International League against Epilepsy) had the task to outline the importance of therapeutic monitoring of anticonvulsant serum concentrations. The possibility of determining the serum concentration of anticonvulsants induced the elaboration of "therapeutic drug level ranges". The usefulness of determining serum concentrations of antiepileptic drugs in clinical management of patients with epilepsy depends decisively on the following questions: Can the efficacy of antiepileptic drug treatment be increased by serum concentration monitoring? Can the rate of adverse effects of antiepileptic drugs be reduced by serum concentration monitoring? Clinical experience suggests numerous indications of therapeutic drug monitoring, scientific studies however, supporting these empirical guidelines are not available. Therefore, therapeutic drug monitoring may be restricted for some special situations which have to be justified in every single case. Tailored determinations with specific purposes are e.g.: resistance to therapy, including suspected irregular intake; suspected intoxication, particularly during combined therapy; the possibility of significant changes in the dosage-serum concentration relationship (interactions with other drugs, unusual pharmacokinetics in childhood, in pregnancy etc.).

Adult↗
PubMed1999

Negative potential shifts and the prediction of the outcome of neurofeedback therapy in epilepsy.

About two-thirds of epilepsy patients who learn to control their slow cortical potential shifts (SCP) reduce their seizure rate, but the remaining third does not demonstrate clinical improvement. In the present study, this finding was replicated in a group of 27 patients with focal epilepsy. We found that patients who consistently produced larger negative SCP in all conditions during the first phase of treatment, showed no decrease in seizure frequency during the six-month follow-up, as compared with the three-month baseline phase. The large negative SCP explained about one-third of the variance of the clinical outcome. Age, medication, seizure history, or the localization of focus were found to be unrelated to clinical improvement.

Adult↗
PubMed1998

[Successful induction of tolerance in an epilepsy patient with phenobarbital allergy].

We report on a 32-year-old female patient who had had a history of complex partial seizures since the age of 14. Phenobarbital was the most effective anticonvulsant drug in this patient. However, the drug treatment was complicated by a phenobarbital-induced exanthematous eruption. Reintroduction of the phenobarbital some years later resulted in a skin rash again; therefore, treatment with this substance had to be discontinued a second time. Because of the satisfactory antiepileptic efficacy, phenobarbital was introduced a third time using a desensitization procedure with increased oral doses, starting with a dose of 1 mg. After a daily dose of 90 mg phenobarbital, on day 6 an exanthematous eruption appeared. The exanthem disappeared parallel to a dose reduction of phenobarbital and with a gradually increasing dosage up to a maintenance dose of 200 mg. Tolerance to the allergic effect of phenobarbital was preserved and the seizure frequency was significantly reduced by phenobarbital monotherapy with a daily dose of 200-175 mg.

Adult↗
PubMed1997

Stability of cortical self-regulation in epilepsy patients.

Biofeedback-supported self-regulation of slow cortical potentials (SCP) is increasingly being used for treatment of intractable epilepsy. However, it is unknown whether the acquired ability to regulate one's own cortical potentials remains stable over time. In this study, 18 patients with drug-resistant partial epilepsy performed 35 training sessions in which they learned to generate slow cortical potential shifts in either positive or negative direction. At the end of training, they differentiated significantly between required cortical positivity and required cortical negativity. Six months after this point, they still demonstrated an unchanged between-condition differentiation. The performance in the booster session was particularly good in trials without continuous SCP feedback. The ability to generate positive SCP shifts was related to decrease of seizure frequency during the 6 months follow-up period compared with the 3 month baseline period. This data indicate that the acquired ability of humans to regulate their cortical potentials did not decrease over a 6 month period but rather, tended to consolidate.

Adult↗
PubMed1996

Self-regulation of slow cortical potentials in epilepsy: a retrial with analysis of influencing factors.

Twenty sessions of biofeedback training were carried out with 12 drug-resistant patients with focal epilepsy who learned to produce either negative or positive shifts of their slow cortical potentials (SCPs) at vertex. Feedback trials were interspersed with transfer trials in which only a discriminative stimulus (signalizing whether positivity or negativity was required) was presented, without feedback signal. Patients were able to differentiate significantly between the conditions of cortical positivity and cortical negativity, with larger differentiation scores being obtained in feedback trials than in transfer trials. The amplitude of positivity generated in the positivity condition increased linearly across sessions both in feedback and in transfer trials. The largest negativity was produced in the 5th session; after this, more transient negativities were generated, whose amplitude decreased towards the end of trial. The mean severity of seizures, estimated as the frequency of seizures weighted by their subjective 'strength', decreased significantly after training as compared to the pre-training phase. The data suggest that (1) patients could learn to achieve a state of cortical disfacilitation and (2) with progressed learning, they became less motivated for (or afraid of) producing considerable negative shifts, since extensive negativity may reflect cortical over-excitation and therefore be associated with early signs of seizures. The inability of producing cortical negativity is however not necessarily a bad predictor.

Adult↗
PubMed1995

Red-cell and serum folate levels in depressed inpatients who commit violent suicide: a comparison with control groups.

There has been some discussion in the recent literature regarding the possible relationship between peripheral levels of folate and serotonin deficiency in the CNS. At the same time, such a serotonin deficiency has been implicated in the biology of suicidal behavior. Thus, decreased peripheral folate levels may be expected in patients who commit violent suicide. In this study, the red-cell and serum folate levels in nine persons who later committed suicide are compared with those in age- and sex-matched control groups. A one-way analysis of variance showed no significant difference between the groups.

Adult↗
PubMed1995

Folate deficiency, anticonvulsant drugs, and psychiatric morbidity.

The folic acid (FOA) level was determined in serum and erythrocytes in 100 epileptic patients and 100 control patients using a luminescence assay. A lowered FOA concentration in serum, erythrocytes, or both was observed in 15% of the epileptic patients and in 2% of the control group. In the epileptic patients, the FOA in the serum and in the erythrocytes was significantly lower than that in the control group. Patients receiving carbamazepine monotherapy had a significantly lower FOA level in the erythrocytes than did patients receiving phenytoin monotherapy. The FOA level showed a negative correlation to the duration of epilepsy. None of the patients with lowered FOA had a normal mental status. The course of the supplementation treatment with 5 mg folinic acid (or FOA) of four patients with FOA deficiency could be monitored psychopathometrically. All four patients showed an improvement in their well-being and the majority of measured variables of the cognitive performance.

Adult↗
PubMed1995

[Differential diagnosis of aggressive behavior in epilepsy].

Aggressive behaviour in epileptics may have many causes which are connected more or less closely with epilepsy. Ictal aggression is very rare. In the case of a patient with complex partial seizures and a schizophrenia-like psychosis different forms of generation of aggressive behaviour are discussed.

Adult↗
PubMed1994

[Psychiatric changes caused by epileptic seizures].

Frequent tonic-clonic seizures could probably lead to psychic disorders. In various studies a decrease in at least single functions of mental capability was found depending on the frequency of the seizures and/or the duration and/or the age of onset of the disease. The development of neuropsychological deficits depends on the type of seizures. Particularly BNS-seizures and the Lennox-Gastaut-syndrome have generally a poor prognosis concerning the intellectual development. Not only clinically manifest seizures but also subclinical discharges could disturb the psychic condition of epileptic patients. Epileptic seizures are probably a reason for neuronal damage in the hippocampus area. Psychogenic reactions and undesired effects of antiepileptic drugs have to be considered aside from functional disturbances due to epileptic seizures.

Anticonvulsants↗
PubMed1993

[Folic acid deficiency in patients hospitalized with depression? A pilot study of clinical relevance].

Seventy-seven depressive inpatients were studied in a pilot study to determine their serum and red cell folate levels at admission. Only one depressive inpatient with a low serum folate value had a history of an illness-related lack of nutrition prior to admission, and the low value was only on day 1 of the study. Our results demonstrate that folate acid deficiency is not as common in depressive inpatients as reported, especially in British studies for two reasons: different eating habits and a methodological problem.

Adult↗
PubMed1992

Clinical relevance of the determination of antiepileptic drugs in serum.

Opinions on the clinical relevance of the determination of antiepileptic drugs in serum are very divergent. Specially the value of routine determinations has not been clarified up to now. At present the determination of antiepileptic drugs is indicated in the following situations: resistance to therapy including suspected irregular intake, adjustment of the serum level into the therapeutic range to prevent under- or overdosage, suspected intoxication (particularly during combined therapy), dosage monitoring when changes in the dosage-serum level relationship might occur, combined therapy, dosage reduction in the absence of seizures, determination of a baseline level in patients with good anticonvulsant control, legal indications, therapy research.

Anticonvulsants↗
PubMed1991

Periodic hypersomnia: case report with biochemical and EEG findings.

We report on a 23-year-old patient with periodic hypersomnia. Electroencephalographic (EEG) background activity for this individual was slightly slowed in the EEG during an episode of hypersomnia, and intermittent slow activity was found in addition. Usual laboratory parameters were normal; however, leucine-enkephalin was markedly elevated in the plasma at that time, whereas free cysteine could not be demonstrated. Clinical findings were normal in the following years, and the EEG background activity returned to normal; leucine-enkephalin and cysteine also returned to normal values.

Adult↗