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Biomedical subjects

Z Martinović

Publications and source records attributed to Z Martinović.

At least 19 recordsLinked to original sources
PubMed2001

Adjunctive behavioural treatment in adolescents and young adults with juvenile myoclonic epilepsy.

This study was designed to assess the effects of behavioural treatment on seizure recurrence, on seizure precipitants, and on associated psychiatric disturbances in 22 adolescents and young adults (age range 16-32 years, male : female ratio 10 : 12) with juvenile myoclonic epilepsy (JME) who showed seizure relapses despite rational AED therapy. The neurological assessment and a systematic search for seizure precipitants preceded to the use of psychiatric interviews and rating scales for anxiety and depression. After a structured counselling aiming at the elimination of seizure precipitants, the patients were assigned to one of two treatment modalities (an antistress programme or an individual cognitive behavioural therapy). Structured counselling was associated with complete seizure control in eight patients. In other 14 subjects with uncontrolled seizures, the psychotherapeutic treatment had two types of effects. First, the patients' fears and other unadapted responses, in the form of anxiety states and/or insomnia were significantly decreased during behavioural treatment. Second, a significantly lower rate of relapses occurred during behavioural treatment than during the baseline period. The results encourage the use of adjunctive behavioural treatment methods in decreasing seizure frequency, seizure precipitants and some types of comorbid psychopathology in patients with JME.

Adolescent↗
PubMed2001

Clinical correlations of electroencephalographic occipital epileptiform paroxysms in children.

A longitudinal prospective approach was used to investigate clinical correlations of interictal occipital paroxysms with or without fixation-off sensitivity (FOS). Occipital paroxysms were recorded in the electroencephalograms (EEGs) of 76 children with heterogeneous clinical conditions including seizures in 39 patients. Occipital paroxysms with FOS (42 patients ) were only fractionally more frequent than non-FOS (34 patients ) and were not specific of any clinical condition. Although present and FOS-related in all 11 children with benign childhood epilepsies with occipital paroxysms (CEOP), they were also frequently encountered in symptomatic occipital epilepsy. The differentiation of CEOP from other syndromes established on clinical grounds could also be aided by the analysis of background EEG activity that was frequently significantly more abnormal in symptomatic than CEOP. Clinical characteristics and ictal seizure semiology as well as follow-up clearly distinguish two type of idiopathic CEOP syndromes: (1) early onset type or Panayiotopoulos syndrome characterized by excellent prognosis and rare, prolonged nocturnal seizures with tonic deviations of the eyes and vomiting, and (2) late onset or Gastaut type showing a common ictal visual symptomatology, co-occurrence of migraine, diurnal complex partial seizures and less favourable EEG-clinical prognosis.

Adolescent↗
PubMed1999

[Video thoracoscopic therapy of recurrent spontaneous pneumothorax].

We report our first experience in surgical treatment of recurrent spontaneous pneumothorax using video-assisted thoracic surgery (VATS). From May 1995 to April 1998, 38 cases of recurrent spontaneous pneumothorax were treated using the VATS approach. All patients were previously treated by other methods (conservative, thoracocentesis, chest-tube drainage). We successfully managed VATS procedure in all our patients (wedge resection 28, bullectomy 1, partial pleurectomy 2, pleural abrasions 36). Complications include persistent air leak (4), prolonged bleeding (1) and supraventricular tachycardia (1). The mean duration of chest drainage was 3.9 days (range 3 to 15 days). All patients received antimicrobial chemoprophylaxis with single-dose of 2 g Ceftriaxone intravenously prior to surgery and average postoperative patient-controlled analgesia with 0.15 mg of buprenorphin. Utilisation resource analysis showed great advantage in favour of VATS procedure compared to retrospectively analysed thoracotomied patients. We conclude that VATS is very useful alternative to conventional thoracotomy in managing cases of recurrent spontaneous pneumothorax.

Adult↗
PubMed1998

EEG power spectra of normal preadolescent twins. Gender differences of quantitative EEG maturation.

To determine developmental changes of quantitative EEG maturation, we investigated the electroencephalogram (EEG) power spectra in a sample of 72 pairs of healthy twins (144 subjects, 75 girls and 69 boys) ranging in age from 7-15 years. Main spectral parameters were measured in 16 EEG channels. The statistical significance of differences in the EEG power spectra was compared in relation to age and gender. Gender differences were tested by comparing the EEG parameters of boys and girls in the whole sample and separately in the subgroup of dizygotic twins of the opposite sex (DZO twin pairs). A statistically significant decrease of absolute power occurred with increasing age. A significant redistribution of relative power also appeared in higher age, mainly consisting of a progressive increase of alpha 2 power inversely related to relative alpha 1 and theta power. Polynomial regression models of the relation between alpha 2 and theta relative power with age were best described by a 5-order function. The mean frequency of activity across all spectra also increased with age and was maximal in the eldest subjects (13-15 years), with a significantly higher mean frequency of alpha 2 power in females. Similar age and gender differences were less marked in the subgroup of DZO twin pairs. The topographic distribution of spectral bands in normal subjects suggested an earlier maturation of midparietal or occipital than frontocentral regions, and indicated that the growth spurt does not occur simultaneously over homologous right and left hemisphere regions at the same age.

Adolescent↗
PubMed1997

Seizure recurrence after a first generalized tonic-clonic seizure, in children, adolescents and young adults.

A sample of 78 patients (32 females and 46 males) who had a first unprovoked generalized tonic-clonic seizure between the age of 3 and 21 years was studied prospectively. Duration of follow-up was 2-10 years (mean 5.2 years). A second seizure occurred in 69.2% (54 of 78), most commonly (38 of 54, 70.37%) in the first three months after the first seizure. There were no significant differences in the total number of relapses among various aetiological groups. For idiopathic aetiology, seizure recurrence was significantly more common if the first seizure occurred during sleep (24 of 29, 82.75%) than in the waking state (5 of 13, 17.25%). The second seizure occurred in the same state, i.e. night sleep or awake in 72.2% (39 of 54) of patients. The presence of epileptiform patterns in the first two EEGs in the waking state or in sleep was significantly associated with a highly increased risk of seizure recurrence.

Adolescent↗
PubMed1995

Fictitious epilepsy in Munchausen syndrome by proxy: family psychodynamics.

This paper presents experience of Munchausen Syndrome by Proxy in four families where symptoms and signs of seizures in children were deliberately fabricated or induced by their own parent. At the time when the condition was suspected, the children (5, 7, 13 and 14 years old) had already been exposed to numerous investigations and antiepileptic drug intake-in one case resulting in drug intoxication. The important data, giving clues about how to uncover the condition, are peculiar to each family. After the condition was confirmed, a multidisciplinary team organized an approach aimed at protecting the abused child and changing the pathological parent-child relationship. Personality disorders were recognized in all illness perpetrators (the father in one and the mother in three families) and various psychopathological manifestations were present in all of the abused children. Psychodynamic factors causing the Manchausen Syndrome by Proxy are described and discussed.

Adolescent↗
PubMed1990

Pattern-reversal visual evoked potentials recorded in children with generalized epilepsy.

Visual potentials evoked by pattern reversal (PRVEPs) were studied in 64 normal subjects (age range 7 to 15 years) and in 15 patients with primary generalized epilepsy (age range 8 to 13 years), 10 of whom were without anticonvulsant medication. Most of them were studied during sodium valproate (VPR) therapy and some during carbamazepine (CBZ) medication. A Quadristim set (Alvar) was used to present checkerboard patterns on a TV monitor, to amplify the EEG signals and to average and plot the evoked potentials. The potentials were elicited by binocular full-field 2/s checkerboard reversals, recorded from an electrode 4 cm above the inion, and analyzed for latency, amplitude and waveform. Our PRVEP measurements examined peak latency of positive P2 (or P100) component and trough-to-peak amplitude on N1P2 wave complex. The degree of similarity between pairs of PRVEP plots were determined by Pearson correlation coefficient r for an analysis time of 150 ms. In most of our patients, no pronounced influence of the disease itself on the parameters and waveform of the normal PRVEP pattern was demonstrated if anticonvulsant drugs were not taken. In patients who were under complete seizure control, the anticonvulsant did not change the PRVEP morphology as well. The PRVEP abnormality was most pronounced in patients who were taking anticonvulsant medication, but whose seizures were poorly controlled. This pattern distortion can be revealed by the correlation coefficient, but not by other PRVEP parameters. Therefore, this coefficient may be useful as a sensitive and objective measure both of PRVEP distortion and PRVEP improvement. Our results give further evidence that nondemyelinating disorders, but with synaptic transmission defects, can produce measurable changes in PRVEP morphology.

Adolescent↗
PubMed1990

Pattern-reversal visual evoked potentials in children with migraine: a correlation analysis.

Visual potentials evoked by pattern reversal (PRVEPs) were studied in 64 normal children (age range 7 to 15 years) and in 20 age-matched patients with common and complicated migraine (age range 6 to 16 years). Most of them were studied before and during prophylactic therapy. A Quadristim set (Alvar) was used to present checkerboard patterns on a TV monitor, to amplify the EEG signals and to average and plot the evoked potentials. The potentials were elicited by binocular full-field 2/s checkerboard reversal, recorded from an electrode 4 cm above the inion, and analyzed for latency, amplitude and waveform morphology. The degree of similarity between pairs of PRVEPs was determined by the correlation coefficient. In all our patients no pronounced influence of the disease itself was demonstrated on the PRVEP latencies and amplitudes, but in most of them the correlation coefficients were significantly different from that showing the measure of normal PRVEP variations. Prophylactic medication influenced non-significant increase of the coefficient. This increase seems to be related to recovery from medication in terms of attack frequency. No significant difference in PRVEP results of common and complicated migraine was noticed. The PRVEP distortion can be revealed by the correlation coefficient but not by other PRVEP parameters. Therefore, this parameter may be useful as a sensitive measure of both PRVEP distortion and PRVEP improvement. Our results give further evidence that non-demyelinating disorders, but with ischemic damage and abnormalities in neurotransmitters, can produce measurable changes in PRVEP morphology.

Adolescent↗
PubMed1990

Electroencephalographic findings in coma caused by fatal chloroquine poisoning.

A 19-year-old patient in deep anoxic coma after cardiopulmonary arrest due to suicidal acute overdosage of chloroquine was resuscitated at the intensive care unit. An EEG starting about 12 hours later and lasting for 93 minutes showed a rapid succession of diffuse ectopic rhythms, diffuse slow output, generalized periodic slow waves in paroxysmal episodes which preceded burst suppression patterns and definite establishment of electrocerebral silence. All these EEG patterns indicating a poor prognosis were registered about three hours before the patient died during irreversible ventricular fibrillation.

Adult↗
PubMed1989

Pattern-reversal visual evoked potentials in normal 7- to 15-year-old twins: a correlation analysis.

Pattern-reversal visual evoked potentials (PRVEPs) were tested in 11 sets of monozygotic (MZ) twins and 22 sets of dizygotic (DZ) twins matched on age, sex and educational level. They ranged in age from 7 to 15 years. The PRVEPs of MZ twins exhibited a significantly greater degree of similarity than those of DZ twins. The peak latencies and amplitudes of PRVEP components obtained from MZ twin pairs were significantly correlated. The correlation coefficients for the peak latencies of the P2 (or P100) component were the only ones to differ significantly between the DZ twins of the same sex and DZ twins of opposite sexes. These coefficients, obtained using PRVEPs, were much greater than those obtained with flash visual evoked potentials.

Adolescent↗
PubMed1989

Some uses of visual evoked potentials in the diagnostics of neurological disorders in developmental period.

The diagnostic value of visual evoked potentials (VEP) was assessed in a sample of 146 patients aged from 4 months to 18 years with a variety of visual disorders, and in 81 healthy controls. The methods of stimulation consisted of 1) a series of pattern reversals (PR) in 105 fully cooperative patients aged 6-18 years, or 2) a series of diffuse flashes in 41 infants, small children and mentally retarded subjects. The ranges of normal VEP parameters were defined by comparison of the subjects' groups with healthy controls of the same age and sex, who were recently tested by the same methods developed in our laboratory. The incidence of various VEP abnormalities was related to clinical findings and other investigations carried out with the scope to establish the localization and/or the disease etiology. The greatest localizing validity of VEP was found in patients with unilateral visual disorders, while the highest frequency of the most different types of VEP abnormalities was found in subjects with multiple sclerosis. Although nonspecific for any etiology, VEP abnormalities represent a sensitive screening method aimed to discover and to follow-up possible progression of visual dysfunction in children and adolescents. Since VEP, particularly of PR type, allow monitoring of subtle influences on the neuronal cortical functions, its full diagnostic value in the developmental neurology should be determined by further studies.

Adolescent↗
PubMed1986

Periodic generalized bursts of fast waves in subacute sclerosing panencephalitis.

First periodic EEG phenomena in an 8-year-old boy with proven SSPE consisted of generalized fast waves (PGFWs) concurrent with periodic involuntary movements. Since the great variability and unspecificity of EEG changes in the early stage of SSPE could make diagnostic difficulties, the appearance of PGFW in a patient with a clinical picture reminiscent of SSPE should always prompt immunologic investigations aimed at the confirmation of this disease.

Child↗
PubMedDate not supplied

[Idiopathic partial epilepsy with occipital paroxysms].

BACKGROUND: The syndrome of idiopathic partial epilepsy with occipital paroxysms in the electroencephalogram (EEG) shows a considerable clinical and prognostic heterogeneity. The semiology of seizures varies considerably among patients and its hallmark, occipital paroxysms blocked by eye opening, may appear in other idiopathic or symptomatic epilepsies of childhood and even in nonepileptic disorders, notably basilar artery migraine. To address these unresolved issues in children with this rare form of epilepsy, the present paper utilized a longitudinal approach and investigated the significance of electrophysiologic and clinical characteristics necessary for the diagnostic and prognostic evaluation during a long-term follow-up. PATIENTS AND METHODS: Over a 9-year period all patients, aged 1-15 years, who showed occipital paroxysms in EEG recordings were included in this study. In addition, clinical correlates were available for all these patients. Neurological, psychiatric and other clinical examinations were done in all patients. Whenever indicated, the neuroimaging of the brain (computerized tomography and/or magnetic resonance) was performed to establish the symptomatic aetiology. The epileptic syndromes were determined according to criteria of the International classification. A detailed EEG analysis of all patients, performed during a 3-12 year follow-up period, included hyperventilation, photic stimulation and a thorough testing of visual reactivity with exclusion of central vision. The incidence of EEG characteristics in patients with various epileptic syndromes was compared and its significance for the differential diagnosis was tested by nonparametric statistical methods. The clinical semiology of epilepsy and/or other associated disorders and EEG findings were compared among the patients with idiopathic partial epilepsy and occipital paroxysms. RESULTS: Occipital epileptiform paroxysms were recorded in EEGs of 76 children with various clinical diagnoses but only 58 patients had seizures. The incidence of epilepsy (39 patients or 51%) was slightly higher than that of various non-epileptic disorders (37 patients or 49%). Two types of these paroxysms were analyzed: reactive (appearing at exclusion of central vision and disappearing on eye opening) or unreactive (persisting in the above situations). The difference in incidence of seizures (in a total of 58 patients) depending on the types of paroxysms was not statistically significant. EEG characteristics in 25 patients with both reactive paroxysms and seizures were compared in relation to the aetiology of epileptic syndromes. Comparing EEG in various types of epilepsy with reactive paroxysms, the statistical analysis (using Fischer's exact test) established that slowed background activity was significantly more frequent in symptomatic partial epilepsy than in idiopathic syndromes. On the other hand, EEG normalization during the follow-up period was a rule in benign epilepsy with centro-temporal paroxysms and in childhood absence epilepsy, and it was significantly more frequent in idiopathic partial epilepsy with occipital paroxysms than in symptomatic partial epilepsy. However, EEG findings per se cound not differentiate idiopathic partial epilepsy with occipital paroxysms from other epileptic syndromes. Neither seizures semiology could distinguish between different forms of occipital lobe epilepsy. Therefore, a correct syndromic and aetiologic classification for each patient with occipital spike-wave paroxysms required the combined and thorough assessment integrating clinical examination, clinical neurophysiological analyses, and neuroimaging studies during the follow-up. Using all above methods during the follow-up of 11 patients with idiopathic partial epilepsy with occipital paroxysms (IPEOP) it was found that this syndrome had often a very favorable prognosis if characterized by rare, nocturnal seizures beginning in preschool age. (ABSTRACT TRUNCATED)

Adolescent↗