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The prognostic value of residual spikes in the postexcision electrocorticogram after temporal lobectomy 总被引:8,自引:0,他引:8
We correlated the postresection electrocorticograms (ECoGs) of 80 patients who underwent temporal lobectomy under general anesthesia for treatment of intractable complex partial seizures with surgical results in three groups: seizure/aura free (32 patients), auras only (16 patients), and one or more postoperative seizures (32 patients) at mean follow-up times of 34, 31, and 38 months, respectively. Spontaneous "residual spikes," ie, present after all resections, were present in 47% of patients who had no postoperative seizures or auras. However, they occurred in 72% of patients with any postoperative seizures (p less than 0.05). The location (convexity, mesial, or edge of resections) or the distribution (unifocal versus multifocal) of the residual spikes was not of prognostic value. Quantitative studies in 5-minute epochs of the postexcision ECoGs did not reveal a significant difference in the morphology of the residual spikes, ie, the amplitude or firing pattern (single versus polyspike), in the three groups. The group with postoperative seizures showed a higher number of spikes per epoch (greater than or equal to 50), but it was not significant. Although the study shows that patients with residual spikes may have good prognosis, they are at significantly higher risk for postoperative seizures as compared with those without residual spikes. The possibility that intensity of firing of residual spikes may be an additional predictor of outcome warrants further study. 相似文献
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In patients operated for medically refractory epilepsy, ECoGs are often performed to help further localize the epileptogenic focus. During the necessarily short recording, spikes may be rare or absent, or may be only a partial representation of the epileptic activity. The usefulness of background abnormality in localizing the focus in ECoGs was therefore determined. The relationships of MRI, CT, and pathological findings with ECoG background were also noted. The ECoGs of 40 patients were recorded. Delta activity was evaluated by spectral analysis. In 22 ECoGs, maximum delta activity coincided spatially with maximum spiking or was adjacent to it. The region of maximum delta activity rarely coincided with CT, MRI and pathological findings. Although the relationship between delta activity and spiking was much stronger than expected by chance, it may not be sufficient to allow the use of delta activity to localize a focus in individual cases. 相似文献
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R L Kettering M Harrow L Grossman H Y Meltzer 《The American journal of psychiatry》1987,144(9):1154-1160
To determine whether delusional depression has a different clinical course from other types of depression, the authors followed up 31 unipolar delusional depressed patients, 28 unipolar nonpsychotic depressed patients, and 51 schizophrenic patients 14 months after hospital discharge. Patients were assessed on 1) overall outcome, 2) psychotic, anxiety-neurotic, and depressive symptoms, 3) social and work functioning, and 4) rehospitalization. The delusional depressed patients showed significantly more mood-incongruent delusions at follow-up. Surprisingly, the nonpsychotic depressed patients exhibited more depressed mood and significantly more anxiety at follow-up. The findings suggest that the diagnostic distinction between delusional and nonpsychotic depression is relevant to the clinical course of major depression. 相似文献
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Sobów T 《Psychiatria polska》2004,38(2):321-330
Memantine is an NMDA receptor antagonist with moderate affinity, which results in neuroprotective potential due to reducing overstimulation caused by glutamate (excitotoxicity) and simultaneous lack of adverse events (especially psychosis) typical for an antagonist with higher affinity like phencyclidine. In randomized, controlled studies it has been shown that memantine is beneficial in the treatment of moderate to severe dementia of Alzheimer's type and it became the very first compound to be registered for this purpose both in Europe (including Poland) and in the United States. Further investigation require usefulness of memantine in less advanced stages of Alzheimer's disease as well as other types of dementia especially vascular; promising results are shown in dual therapy: memantine + cholinesterase inhibitor. 相似文献
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Nishida T Kudo T Inoue Y Nakamura F Yoshimura M Matsuda K Yagi K Fujiwara T 《Epilepsia》2006,47(12):2104-2114
PURPOSE: To clarify the differences between postictal mania (PIM) and postictal psychosis (PIP). METHODS: Five patients with PIM were compared to 17 patients with PIP, with respect to clinical, epileptological, electrophysiological, and neuroimaging features. PIM was distinguished from PIP by the symptoms observed in the postictal period based on the ICD-10 criteria. RESULTS: Postictal manic episodes lasted for a longer period than postictal psychotic episodes. Patients with PIM had more recurrent postictal episodes than patients with PIP. The age at onset of epilepsy in patients with PIM was older than that in patients with PIP. PIM was associated with frontal lobe and temporal lobe epilepsies, whereas PIP was associated with temporal lobe epilepsy. The estimated epileptogenic zone was on the language dominant side in PIM, whereas there was no predominant hemispheric laterality in PIP. Electroencephalography (EEG) performed during the early period of postictal manic and psychotic episodes showed decreased frequency of interictal epileptiform discharges in both PIM and PIP. Single-photon emission computed tomography (SPECT) during postictal manic and psychotic episodes showed increased perfusion in the temporal and/or frontal lobes in both PIM and PIP. Three patients with PIM showed increased perfusion during postictal episodes on bilateral or the language nondominant side, which were contralateral to the estimated epileptogenic zone, whereas three patients with PIP showed increased perfusion on the areas, which were ipsilateral to the estimated epileptogenic zone. CONCLUSIONS: PIM has a distinct position among the mental disorders observed in the postictal period. 相似文献
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Shawver L 《The Journal of the American Academy of Psychoanalysis》1998,26(4):599-618
Clinical differends are collisions of language-games in which people become baffled as to the other's meaning. This confusion creates anxiety and speechlessness, which disables their linguistic creativity to communicate effectively. In order to dispell this confusion, one needs to acquire the ability to negotiate a mutual set of rules for local conversation and to navigate these local local definitions without offending. Psychoanalysis can promote this flexibility by relying on the common-sense tactic of asking people what they mean by the words they use, by exploring their meaning in some depth, and by negotiating a nonoffensive local and provisional language with the patient that allows the patient to create a vocabulary for saying what needs to be said. 相似文献
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We report a 70-year-old man who developed theophylline-associated seizure with postictal fever and postictal pleocytosis. He was admitted to our hospital for a left hemiconvulsion lasting for two hours. The concentration of theophylline was high (21.6ng/ml), and electroencephalogram demonstrated periodic lateralized epileptiform discharges. Diffusion-weighted magnetic resonance imaging showed high signal intensity lesions in the right cingulated gyrus, insula and thalamus. Temperature above 38.0° was detected 5.5 hours after seizure and lasted for 60 hours. Cerebrospinal fluid (CSF) analysis on day 2 demonstrated pleocytosis (62/uL) with a predominance of polymorphonuclear leukocytes (90%). Temperature and CSF pleocytosis subsided after sedation. Intracranial inflammatory or infectious disease is the first consideration in epilepsy with fever and CSF pleocytosis, and then diagnosis of postictal fever and postictal pleocytosis should be made only by rigorous exclusion of that possibility. 相似文献
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E Niedermeyer 《Clinical EEG》2003,34(3):93-98
There is need nowadays to re-emphasize the capabilities of electroencephalography: a method representing the extremely important function/dysfunction-orientation in neurological thinking and practice. Valuable and relevant messages to the clinician naturally require solid EEG training and the resulting expertise. The idea that valuable EEG information is limited to the field of epileptology is erroneous. A plethora of clinically relevant messages can be derived from the EEG in nonepileptic conditions and, above all, in metabolic (and so called "mixed") encephalopathies where neuroimaging has almost nothing to offer. The discussion of EEG and epileptology only skirts pediatric conditions (and most of the epileptic syndromes). It is shown that EEG reading in epileptology is a lot more than simply "hunting spikes." A strong plea is being made against the presently fashionable overuse of the term "non-convulsive status epilepticus." Continuing neglect of functional/dysfunctional orientation can seriously endanger the entire field of Neurology. 相似文献
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The clinical relevance of ferritin concentration in the cerebrospinal fluid. 总被引:4,自引:1,他引:3 下载免费PDF全文
C J Sindic D Collet-Cassart C L Cambiaso P L Masson E C Laterre 《Journal of neurology, neurosurgery, and psychiatry》1981,44(4):329-333
By means of a new technique (Particle Counting Immunoassay), we have determined the level of ferritin in 470 samples of cerebrospinal fluid of patients with various neurological disorders. The median value obtained in a control group was 2.3 ng/ml with an upper limit at 5.5 ng/ml. the concentrations in the serum and cerebrospinal fluid were independent, but that in cerebrospinal fluid correlated with its total protein content. High values of ferritin were found in infectious meningo-encephalitis, in vascular diseases of the central nervous system, and, unexpectedly, in several cases of dementia without obvious vascular pathology. 相似文献
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D Ramchandani 《American journal of psychotherapy》1989,43(2):238-247
After briefly reviewing various contributions to the concept of projective identification, the author describes the clinical manifestations of this defense. These include (1) disownment and redirection of an intolerable experience to another, (2) manipulation of the recipient in an attempt to control, and (3) an induction of congruent responses in the recipient. The author then discusses the relevance of this concept from a diagnostic and treatment perspective. 相似文献
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ObjectivesSleep–wake disturbances, such as sleep irregularity, are common in bipolar disorder. Early studies suggest that sleep irregularity is associated with mood symptoms in bipolar disorder, but little research has been conducted to identify other correlates of sleep irregularity. We investigated the relationship between sleep irregularity and sleep quality, social rhythms, eveningness, sleep-related cognitions and behaviors, and past and future mood episodes in 84 patients with inter-episode bipolar I or II disorder.MethodsThis is a retrospective and prospective, naturalistic follow-up study. The Expanded Consensus Sleep Diary, Pittsburgh Sleep Quality Index (PSQI), Social Rhythm Metric (SRM-II-5), Composite Scale of Morningness (CSM), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS-16), and Sleep Hygiene Practice Scale (SHPS) were administered. The Square Successive Difference (SSD), derived from a week-long sleep diary, was used as an index of sleep irregularity. Multilevel modeling analysis, which adjusts for biases in parameter estimates, was used to minimize the impact of missing data. Bonferroni correction was performed to account for multiple testing.ResultsHigher SSD scores of sleep diary variables were significantly associated with higher PSQI, SRM-II-5, DBAS-16, and SHPS scores. Irregularity in total sleep time was related to more depressive episodes in the past 5 years (p = .002), while irregularity in wake after sleep onset predicted the onset of depressive episodes over the next 2 years (p = .002).ConclusionSleep irregularity was associated with poor sleep quality, irregular social rhythms, dysfunctional sleep-related cognitions and behaviors, and greater number of depressive episodes in bipolar disorder. 相似文献
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The advances of genome‐wide ‘discovery platforms’ and the increasing affordability of the analysis of significant sample sizes have led to the identification of novel mutations in brain tumours that became diagnostically and prognostically relevant. The development of mutation‐specific antibodies has facilitated the introduction of these convenient biomarkers into most neuropathology laboratories and has changed our approach to brain tumour diagnostics. However, tissue diagnosis will remain an essential first step for the correct stratification for subsequent molecular tests, and the combined interpretation of the molecular and tissue diagnosis ideally remains with the neuropathologist. This overview will help our understanding of the pathobiology of common intrinsic brain tumours in adults and help guiding which molecular tests can supplement and refine the tissue diagnosis of the most common adult intrinsic brain tumours. This article will discuss the relevance of 1p/19q codeletions, IDH1/2 mutations, BRAF V600E and BRAF fusion mutations, more recently discovered mutations in ATRX, H3F3A, TERT, CIC and FUBP1, for diagnosis, prognostication and predictive testing. In a tumour‐specific topic, the role of mitogen‐activated protein kinase pathway mutations in the pathogenesis of pilocytic astrocytomas will be covered. 相似文献
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Brain atrophy has emerged as a clinically relevant component of disease progression in multiple sclerosis. Progressive loss of brain tissue bulk can be detected in vivo in a sensitive and reproducible manner by MRI. Clinical studies have shown that brain atrophy begins early in the disease course. The increasing amount of data linking brain atrophy to clinical impairments suggest that irreversible tissue destruction is an important determinant of disease progression to a greater extent than can be explained by conventional lesion assessments. In this review, we will summarise the proposed mechanisms contributing to brain atrophy in patients with multiple sclerosis. We will critically discuss the wide range of MRI-based methods used to quantify regional and whole-brain-volume loss. Based on a review of current information, we will summarise the rate of atrophy among phenotypes for multiple sclerosis, the clinical relevance of brain atrophy, and the effect of disease-modifying treatments on its progression. 相似文献