Brain volumes in adolescents with very low birth weight: effects on brain structure and associations with neuropsychological outcomes

The aims of this study were to examine abnormalities in brain structure in adolescents and young adults with very low birth weight (VLBW, <1,500 g) and associations of these abnormalities with neuropsychological outcomes. The sample of 108 participants from 14 to 19 years of age included 37 participants with <750 g birth weight, 35 with 750-1,499 g birth weight, and 36 normal birth weight (NBW) controls. One or both of the VLBW groups had smaller brain volumes, larger lateral ventricles, and a small surface area of the corpus callosum than the NBW controls. Group differences in white matter (WM) structures, subcortical gray matter (GM), and the cerebellum were found even when controlling for whole brain volume (WBV), and were most pronounced in the <750 g group. WM reductions in the two VLBW groups relative to NBW controls were associated with more pervasive cognitive deficits than were reductions in subcortical GM. Associations of cognitive outcomes with structural abnormalities remained when controlling for WBV or neonatal risks. The results are consistent with previous findings of residual brain abnormalities in adolescents and young adults with VLBW and provide new information on their cognitive correlates.     

L'epilessia postoperatoria nei meningiomi endocranici

Riassunto Gli AA. studiano le manifestazioni epilettiche postoperatorie osservate in una statistica di 196 casi di meningiomi sopratentoriali radicalmente asportati. II periodo medio di osservazione di questi malati corrisponde a oltre 6 anni. 112 di essi presentavano disturbi epilettici già prima dell'intervento. Postoperatoriamente questi disturbi si risolvevano subito in 49 casi (43%); persistevano transitoriamente in 38 (34%); persistono tuttora in 25 (23%) con caratteri clinici ed EEG. sostanzialmente uguali a quelli preoperatori nella maggioranza dei casi. Ció lascia supporre che, in questi, il focolaio epilettico costituitosi in conseguenza del tumore persista dopo l'asportazione del tumore stesso. Nei casi, invece, nei quali i disturbi comiziali si modificavano dopo l'intervento l'effetto delle lesioni corticali indotte dalle manovre di exeresi del tumore potrebbe giustificare queste modifiche.84 casi non presentavano preoperatoriamente disturbi comiziali. Dopo l'intervento, questi insorgevano in 19 casi (22.6%). Le forme precoci (7 casi) si risolvevano quasi sempre nell'immediato decorso postoperatorio: le forme tardive, invece, (12 casi), cronicizzavano nella metà dei casi.Gli AA. prendono in esame i possibili fattori responsabili del costituirsi dei focolai epilettici cronici e rilevano che nei malati nei quali l'epilessia si risolve ciò non é da attribuirsi alla terapia anticonvulsiva.

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Summary The authors investigated the development of postoperative epilepsy in a series of 196 supratentorial meningioma patients who underwent radical surgery. The mean follow-up period was 6 years. One hundred and twelve patients had had epileptic disturbances before the operation. Postoperatively, the fits stopped immediately in 49 patients (43%); the fits persisted for a short time in 38 patients (34%); in 25 patients (23%) the fits continued with the clinical and E.E.G. characteristics virtually unchanged from the preoperative state in the majority of patients. From this one could conclude that in these patients the epileptogenic focus produced by the tumor, continued to exist in spite of removal of the tumour. On the other hand it is to be assumed that with patients in whom the operation led to a change in the frequency of fits, this alteration was caused by manipulation of the cortex during the tumour removal.Eighty-four patients had no fits pre-operatively. Of these patients 19 (22.6%) developed fits postoperatively. The early form (7 patients) almost always cleared up in the early postoperative period. In contrast, with the twelve patients with late fits half of them developed chronic epilepsy.The authors took into consideration all the factors which could possibly lead to the development of a chronic epileptogenic focus and stressed that in their patients cured of epilepsy this cure is not to be attributed to anticonvulsivant therapy.

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Zusammenfassung Die Autoren untersuchten das Auftreten postoperativer Epilepsie an einer Serie von 196 supratentoriellen, radikal operierten Meningeomen. Die mittlere Nachbeobachtungszeit betrug 6 Jahre. 112 Fälle hatten bereits vor dem Eingriff epileptische Störungen gehabt. Postoperativ hörten diese Störungen bei 49 Fällen (43%) sofort auf; vorübergehend traten bei 38 Fällen (34%) noch welche auf; bei insgesamt 25 (23%) blieben sie bestehen, wobei die charakteristischen klinischen und EEG-Befunde bei den meisten dieser Fälle gegenüber den praeoperativen praktisch unverändert blieben. Daraus läßt sich schließen, daß bei diesen Fällen der epileptogene Fokus, der vom Tumor verursacht worden war, trotz Entfernung des Tumors weiterbestand. Andererseits ist anzunehmen, daß bei Fällen, bei denen es nach dem Eingriff zu einer Änderung des Anfallsgeschehens gekommen ist, diese Änderung durch das Manipulieren am Kortex bei der Tumorentfernung verursacht worden ist.84 Fälle hatten praeoperativ kein Anfallsleiden. Davon entstand eines postoperativ bei 19 Fällen (22,6%). Die Frühformen (7 Fälle) heilten fast immer schon im anfänglichen postoperativen Verlauf; bei den Fällen mit später Manifestation (12) entwickelte sich dagegen bei der Hälfte ein chronisches Anfallsleiden.Die Autoren stellten Überlegungen über die Faktoren an, die möglicherweise für die Entstehung eines bleibenden epileptogenen Fokus verantwortlich sind und heben hervor, daß bei den Patienten, bei denen die Anfälle ausgeheilt sind, dieses unabhängig von antikonvulsiver Behandlung erfolgte.

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Resumen Los autores han estudiado las epilepsías post-operatorias en una série de 196 enfermos que habían sido sometidos a una ablación total de meningiomas supratentoriales. Estos operados fueron seguidos durante 6 años. Ciento doce enfermos presentaban crisis comiciales antes de la intervención. Después de la operación las crisis desaparecieron inmediatamente en 49 casos (43%). Las crisis persistieron durante un corto periodo de tiempo en 38 casos (34%). En 25 casos (23%) las crisis han persistido con las mismas características clinicas, asi como el E.E.G. preoperatorio. Estos últimos casos hacen suponer que el foco epileptógeno engendrado por el tumor persistía a pesar de la extirpación del tumor. Por el contrario en los operados en los cuales la operacion ha modificado la frecuencia de las crisis es evidente que esta modificación está unida a la manipulación de la corteza durante la extirpación del tumor.Ochenta y cuatro enfermos no habían tenido crisis epilépticas antes de la intervención. Entre ellos 19 (22,6%) presentaron crisis después de la intervención. Las crisis precoces (7 casos) casi siempre han desaparecido en el curso post-operatorio. Por el contrario los 12 operados que presentaron crisis tardías han desarrollado una opilepsía crónica.Los autores han tenido en cuenta todos los factores capaces de favorecer el desarrollo de un foco epileptógeno crónico, e insisten sobre la necesidad de tratamiento con anticonvulsivantes en todos los enfermos portadores de un foco epileptógeno aunque las crisis hayan o no desaparecido.

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Résumé Les auteurs ont étudié les épilepsies post-opératoires dans une série de 196 malades ayant subi une ablation totale de méningiome supratentoriel. Ces opérés ont été suivis pendant 6 ans. Cent douze malades avaient présenté des crises comitiales avant l'intervention. Après l'intervention, les crises ont disparu immédiatement dans 49 cas (43%). Les crises ont persisté pendant une courte période dans 38 cas (34%). Dans 25 cas (23%) les crises ont persisté avec les mêmes caractères cliniques et E. E. G. qu'avant l'intervention. Ces derniers cas laissaient supposer que le foyer épileptogène engendré par la tumeur demeurait malgré l'ablation de la tumeur. Par ailleurs, chez les opérés dont l'intervention a modifié la fréquence des crises, il est certain que cette modification est liée à la manipulation du cortex au cours de l'exérèse de la tumeur.Quatre vingt quatre malades n'avaient pas eu de crises épileptiques avant l'intervention. Parmi eux, 19 (22,6%) ont présenté des crises après l'intervention. Les crises précoces (7 cas) ont presque toujours disparu dans les suites opératoires. Au contraire, parmi les 12 opérés qui ont présenté des crises tardives, 6 ont développé une épilepsie chronique.Les auteurs ont envisagé tous les facteurs favorisant le développement du foyer épileptogène chronique. Ils ont insisté que dans les cas guéris de l'épilepsie, la guérison n'était par la conséquence d'une traitement anticonvulsivant.

     

Augmentation of milnacipran by risperidone in treatment for major depression

Milnacipran, one of the serotonin noradrenaline reuptake inhibitors (SNRIs) to which venlafaxine and duloxetine belong, is a new antidepressant that has recently become available in many countries. Despite the advances in pharmacotherapy, almost one third of patients with depressive illness respond inadequately to monotherapy with such an antidepressant. We herein describe five patients with major depression who responded partially, but not fully, to milnacipran alone and remarkably improved with an adjunct of risperidone. In addition, milnacipran plus risperidone was found to be a useful augmentation for treatment-refractory depression in 3 of the 5 patients. The minimum dose of risperidone, 0.5 or 1 mg/d, was efficacious. The time of response after addition of risperidone was within 4 d. Our experience suggests that an augmentation therapy of milnacipran plus risperidone is useful for treating patients with depression who only partially respond to various types of antidepressants and for treatment-refractory depression.     

Metabolite alterations in basal ganglia associated with psychiatric symptoms of abstinent toluene users: a proton MRS study.

Long-term toluene abuse causes a variety of psychiatric symptoms. However, little is known about abnormalities at the neurochemical level in the living human brain after long-term exposure to toluene. To detect neurochemical changes in the basal ganglia of subjects with a history of long-term toluene use, proton magnetic resonance spectroscopy (1H MRS) was performed in 12 abstinent toluene users and 13 healthy comparisons with no history of drug abuse. N-acetylaspartate (NAA), creatine plus phosphocreatine (Cr + PCr), choline-containing compounds (Cho), and myo-inositol (MI) levels were measured in the left and right basal ganglia. The Cho/Cr + PCr ratio, a marker of membrane metabolism, was significantly increased in the basal ganglia of toluene users in comparison to that of the control subjects. Furthermore, the increase in the Cho/Cr + PCr ratio was significantly correlated with the severity of residual psychiatric symptoms. These findings suggest that long-term toluene use causes membrane disturbance in the basal ganglia, which is associated with residual psychiatric symptoms that persist even after long-term abstinence from toluene use.     

Cocaine decreases self-control in rats: a preliminary report

Cocaine abuse is often associated with behavior that takes into account short-term, but not long-term consequences. However, there has been no empirical research concerning the effects of cocaine on self-control (choice of a larger, more delayed reinforcer over a smaller, less delayed reinforcer). In the present research, when food-deprived rats repeatedly chose between a larger, more delayed food reinforcer and a smaller, less delayed food reinforcer, chronic intraperitoneal injections of 15 mg/kg cocaine (but not 10 mg/kg fluoxetine) decreased the rats' choices of the larger, more delayed reinforcer. Cocaine can decrease rats' self-control.