Epileptic psychoses and their drug treatment

This paper is concerned with classification, clinical-electroencephalographic correlation, principles of treatment, and pharmaceutic therapy of epileptic psychoses. Based on the system of the physically founded reversible psychoses, classification of epileptic psychoses is developed, which is easy to apply for clinical and research purposes. Its principles are the criteria of disturbance of consciousness and of connexion to epileptic seizures. Epileptic psychoses without disturbance of consciousness frequently go along with a forced normalization of epileptic EEG-changes. This clinical-electroencephalographic correlation is documented by the cases of a depressive-paranoid and a cenesthetic alternative-psychosis. Epileptic psychoses connected to seizures, going along with disturbances of consciousness, however, show, without any exception, a pathological changed EEG. Also in the cases of the often iatrogenically produced epileptic psychoses with disturbances of consciousness yet not connected to seizures, the EEG-results are of decisive diagnostic importance. Each of these three clinical-electroencephalographically defined groups of psychoses calls for concentration on particular pathogenetical aspects concerning a specific pharmaceutic therapy. The respective principles of treatment are developed in subtly differentiated ways and they are provided with suggestion as to medicamental treatment. Schizophrenia-like epileptic psychoses are a model for idiopathic schizophrenias and so important perspective opens up for research.     

The efficacy of excimer laser (308 nm) for vitiligo at different body sites

BACKGROUND: The treatment with XeCl-excimer laser generated 308-nm UVB radiation has shown promising results in patients with vitiligo. OBJECTIVE: In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient's satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. METHODS: Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308-nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1-5%), 2 (6-25%), 3 (26-50%), 4 (51-75%), to 5 (76-100%). RESULTS: Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. CONCLUSIONS: 308-nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.     

Homozygous deletion mutations in the plectin gene (PLEC1) in patients with epidermolysis bullosa simplex associated with late-onset muscular dystrophy

In a distinct autosomal recessive variant of epidermolysis bullosa, EB- MD, life-long skin blistering is associated with late-onset muscular dystrophy of unknown etiology. Electron microscopy of these patients' skin suggests that tissue separation occurs intracellularly at the level of the hemidesmosomal inner plaque, which contains plectin, a high molecular weight cytoskeletal associated protein, also expressed in the sarcolemma of the muscle. In this study, we report two patients with EB-MD, each with a homozygous deletion mutation in the plectin gene, PLEC1. In the first case, the proband and her similarly affected sister had a homozygous 9 bp deletion mutation, designated as 2719de19, which resulted in elimination of three amino acids, QEA, in a sequence of 23 amino acids entirely conserved between the mouse and human sequences. The proband in the second family demonstrated a single nucleotide deletion at position 5866, designated as 5866delC, which resulted in frameshift and a premature termination codon for translation 16 bp downstream from the site of deletion. The absence of plectin in the hemidesmosomes, as reflected by negative immunofluorescence with an anti-plectin antibody (HD-1), associated with fragility of basal keratinocytes, implicates plectin as critical for binding of intermediate keratin filament network to hemidesmosomal complexes. The function of plectin as a putative attachment protein also in the muscle would explain the clinical phenotype consisting of cutaneous fragility and muscular dystrophy in EB-MD.      

Are genotypes of Trypanosoma cruzi involved in the challenge of chagasic cardiomyopathy?

Myocardial damage in Chagas' disease differs, depending on the particular Trypanosoma cruzi stock. It is reasonable to expect that the extent of phylogenetic divergence between lineages will have an impact on the biological properties of the parasite. The aim of the present work was to evaluate this impact on the cardiac damage produced by this protozoan. Heart histopathologic lesions were studied in mice infected with 15 cloned stocks of T. cruzi of various origins pertaining to 3 major clones or genotypes (19, 20, and 39) that share 3 different profiles for a given set of genetic markers. Sets of mice were infected intraperitoneally with 10⁶ blood trypomastigotes of each of the T. cruzi clones. The macroscopy study showed a cardiac index (CI) higher than 0.6 (cardiomegaly) in 5 of the 15 stocks studied (33.33%). Inflammatory infiltrates appeared in stocks pertaining to the three genotypes studied without relation to the genetic pattern. Pseudocysts were present at higher levels (83%) in stocks pertaining to genotype 39. A lower rate could be seen in stocks pertaining to genotype 19 (50%). Only one stock pertaining to genotype 20 presented myocardial parasites (20%). Hearts were also studied for lesions in the different cardiac chambers. Inflammatory foci as well as pseudocysts appeared mainly in ventricles, with the left ventricle sharing the highest percentage of pathologic findings. In summary, in spite of the similar inflammatory pattern demonstrated for all stocks studied, the parasite's presence seemed to be related to the genotype of reference, but no relation could be demonstrated with the genetic distances. Received: 4 June 1997 / Accepted: 17 September 1997     

False-negative results by polymerase chain reaction due to contamination by glove powder

The polymerase chain reaction (PCR) technique has become an important, widely employed method for the detection and quantitation of the nucleic acid sequences used in the diagnosis and monitoring of genetic and infectious diseases. Much attention has been directed at the problem of false-positive PCR results, which are generally attributed to low-level laboratory contamination of amplified sequences ("carryover"). In contrast, few investigators have commented on the somewhat less frequent, but equally problematic, false-negative PCR results. Investigation of the source of sporadic false-negative PCR reactions found that glove powder, inadvertently introduced into tubes when gloves are changed in an effort to reduce false-positive results, can nonspecifically inhibit each of the major steps in the PCR detection process. Methodologic precautions are recommended to minimize this problem.     

Studies on the intracerebral metabolism of anticonvulsant drugs--II. Disposition of carbamazepine in the isolated perfused rat brain

Carbamazepine (CBZ) was perfused (85 nmoles/ml) through the isolated brains of rats. After 2 hr the mean regional concentrations of the drug were between 170 and 234 nmoles/g wet weight. The total brain content of CBZ was 390 nmoles. During perfusion 82 nmoles epoxycarbamazepine (E-CBZ) were formed, most of which were found in perfusion medium. Tissue levels of E-CBZ were between 0.3 and 2.8 nmoles/g wet weight. No dihydroxycarbamazepine (DH-CBZ) could be found. Pretreatment of the rats with phenobarbital neither influenced the uptake of CBZ into the brains nor increased the formation of E-CBZ significantly.     

The isolated perfused rat spleen. An original method for studying the function of hepatocytes transplanted into the spleen

The aim of this study was to assess directly the function of isolated hepatocytes 1 year after transplantation into the spleen, using an original model of isolated rat-spleen perfusion. Three specific liver functions, albumin synthesis, indocyanine-green clearance, and antipyrine oxidation, were studied. Five x 10(6) isolated hepatocytes were injected into the spleen of syngenic Wistar-Furth rats. One year later, splenectomy was performed, and the splenic pedicle was carefully isolated in order to allow a selective ex vivo perfusion for 3 hr. De novo albumin synthesis was studied by qualitatively using immunoelectrophoresis and autoradiography, and quantitatively using (35S)-methionine incorporation in albumin. De novo albumin synthesis was observed in spleens containing transplanted hepatocytes but not in controls (P less than 0.001); (35S)-methionine incorporation was significantly higher in spleens containing transplanted hepatocytes than in controls (132 +/- 67 cpm/spleen/hr vs. 14 +/- 6 cpm/spleen/hr, P less than 0.001). Antipyrine clearance was significantly higher in spleens with transplanted hepatocytes than in controls (67.4 +/- 4.9 microliters/min/g vs. 0.2 +/- 0.4 microliters/min/g, P less than 0.01). No statistically significant difference was observed with indocyanine-green clearance (4.2 +/- 6.0 microliters/min/g, vs. 5.2 +/- 5.1 microliters/min/g, P greater than 0.05); this was probably due to the absence of compartmentation between the sinusoid and biliary sectors in this model. In conclusion, using this original isolated rat-spleen perfusion model, it was directly observed that 1 year after transplantation, intrasplenic hepatocytes can perform two liver-specific functions, i.e., de novo albumin synthesis and antipyrine clearance.