Sensorimotor EEG operant conditioning: Experimental and clinical effects

Neurophysiological studies in cats have established a functional relationship between waking 12–15 Hz sensorimotor cortex rhythmic EEG activity (the sensorimotor rhythm or SMR) and a similar pattern during sleep, the sleep spindle. Both result from oscillatory thalamocortical discharge involving ventrobasal thalamus and sensorimotor cortex, and both are associated with a state of suppressed motor excitability. Enhancement of the SMR with operant conditioning methods in the cat clearly led to reduced seizure susceptibility. The experimental application of this approach to seizure control in epileptics has resulted in (A) evidence that EEG patterns can be manipulated significantly in man with operant conditioning, (B) suggestive observations concerning a potential component of pathology in epilepsy, and (C) strong preliminary evidence that SMR operant conditioning in epileptics is specifically therapeutic. Current research has focused upon the EEG during sleep in epileptics with primary motor symptomatology. This measure often reveals several hard signs of pathology. These include the presence of abnormal activity in the 4–7 Hz frequency band and the absence or disturbance of activity in the 11–15 Hz frequency band. Power spectral analysis is being utilized to quantify these sleep EEG components in five groups of epileptic patients, studied with different frequency patterns rewarded in an A-B-A design which provides for counterbalancing of order effects. Initial laboratory training is followed by 9–12 months of training at home with portable feedback equipment. Reward contingencies are reversed within each group at approximately three month intervals. Clinical EEG data, blood anticonvulsant measures and patient seizure logs supplement sleep EEG data obtained before training and after each phase of the design. Early results have again indicated specific therapeutic benefits following training of high frequency rhythmic central cortical activity.     

Genealogic studies in genuine partial epilepsy

Clinical--electroencephalographic (EEG) investigation was performed in 12 families. In the study were included 12 epileptics with partial seizures in whom the katamnestic follow up from 2 to 6 years provided clinical, EEG and genetic data for the so called primary partial epilepsy 24 parents and 14 siblings. In four of the Children with epilepsy the seizures were of the "Rolandic" type; in 5--"psychomotor"; and in 3--hemiconvulsive. No data for structural brain lesion investigation were found. Rapid and long lasting therapeutic effect was achieved in all of the cases. The EEG showed focal paroxysmal activity in all of the diseased and in 11 of the siblings, in 5 of them were found epileptic seizures of the same type as in the probands. The possibilities of a genetic predisposition to development of an epileptogenic focus and its clinical Expression in members of the families in discussed.     

Psychometric studies on the specificity of psychological performance disorders of epileptic patients

Using a psychological test battery for registration of psychic/psychomotoric speed and flexibility/perseveration we examined 78 epileptic patients with different forms of epilepsy and the same number of brain healthy control persons, parallelised in sex, age, education, profession and intelligence. The registrated data were varianz-, correlation- and factoranalised. We found a deceleration of psychic/psychomotoric speed as a primary basic disorder in epileptics. Decreases of flexibility independent of speed were not ascertainable.     

Epileptic psychosis and nonconvulsive status epilepticus with ictal bradycardia and asystole

Case report of a 35 years old patient, who, without previous history of epilepsy, within two years experienced two long-lasting psychotic episodes due to non-convulsive status epilepticus with complex partial seizures. During the second psychotic episode she developed ictal vegetative phenomena such as profuse sweating, flush, apnoea, and, above all and most alarming, periods of severe bradycardia and asystolia with clinical signs of syncope. Ictal asystolia, though being an uncommon sing of epileptic seizures, may be one cause of sudden unexpected death in epileptics.     

Defective stimulus set attention in generalized epilepsy

This study examined auditory selective attention in primary generalized and complex-partial (temporal lobe) epileptics using binaural and dichotic versions of the Continuous Performance Test. The patient groups did not differ from normal controls when only one channel was presented or when divided attention (simultaneously monitoring two channels) was required. However, generalized epileptics had significantly depressed hit rates when directed attention (responding to critical stimuli in only one channel) was required. These results suggest a contribution of brain stem “arousal” mechanisms to stimulus set attention. In addition, right ear perceptual advantages were found on these dichotic monitoring tasks, lending support to the contention that short-term auditory memory and verbal report are not required for the dichotic ear effect.     

Structural differentiation of psychological performances in epilepsy patients

Investigating the specific of psychic performance disorders in epileptics structural aspects in addition to quantitative performance differences are considerable. We compared psychometrically obtained performance structures of epileptic children and adults and of parallelised healthy control persons. It became evident, that the performance differentiation hypothesis is to corroborate also in epileptic patients. The psychic performance structure of epileptics is characterized by a lower differentiation level of the basis functions underlining the performances. Our factor analytic investigations emphasize the importance of deceleration of psychic/psychomotoric speed in epileptics as primary basic disorder.     

The epileptologist Herrmann Andreas Reimer in G?rlitz

Reimer's main merit consists in the fact that he undertook the first attempt in the G?rlitz region to establish a hospital for epileptics. He later abandoned this project and also accepted patients with other neuropsychiatric illnesses (e.g. Minna Herzlieb). The fact that the first building belonging to the hospital for epileptics has survived three wars and still exists makes the town G?rlitz the home of a monument of particular medico-.     

Relationship between automatically analyzed quantitative EEG data and psychological performance parameters in patients with epilepsy

A report is given on results of comprehensive studies in which significant positive correlations between automatically analysed parameters reflecting the frequency behaviour of the EEG background activity and psychometrically recorded relatively complex psychic and psychomotoric tempo performances as well as some partial aspects of the re-adjustment capability in epileptics were found. EEG indicator values could be ascertained which point to psychic performance disturbances in epileptics.     

The assessment of disability in epileptic patients

Report is given concerning 16 epileptics in whom annuity could be suspended. Types of seizures did not differ from those analysed in a formerly study of further invalid epileptics. On the contrary, the beginning of treatment was very soon after manifestation of disease, and the treatment was in the hand of neuropsychiatrists with mostly good or very good attention. Improvement could be obtained mainly by decrease of seizure frequency of freedom from seizures, and after few years invalidity could be annulled.     

Employment of epileptic patients abroad and their fitness for travel

On the basis of relevant literature and from personal experience, the paper discusses problems of the fitness of epileptics to travel by air and to work and holiday abroad. As an aid to consultation, tentative recommendations are made.     

Psychological impact of illness intrusiveness in epilepsy - comparison of treatments

Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these is the concept of illness intrusiveness, the disruption of lifestyles and activities attributable to constraints imposed by chronic disease and its treatment. This study tested the illness intrusiveness theoretical framework in epilepsy and compared the impact of pharmacological and surgical treatments on illness intrusiveness and QOL. Cross-sectional data compared three epilepsy groups (N = 145): (a) 40 patients admitted for presurgical evaluation to an Epilepsy Monitoring Unit; (b) 52 patients treated pharmacologically; and (c) 53 post-surgical patients. Illness intrusiveness differed significantly across epilepsy patients with the differences primarily related to seizure control. Illness intrusiveness varied inversely with seizure control (p < .05). Seizure freedom, whether achieved by surgical or pharmacological treatments, was associated with maximal reduction of illness intrusiveness. Increased illness intrusiveness correlated significantly with decreased QOL and increased depressive symptoms. Perceived control over diverse life domains correlated positively with QOL and psychosocial outcomes. Path analysis supported the validity of the illness intrusiveness theoretical framework in epilepsy. Illness intrusiveness is an important determinant of the psychosocial impact of epilepsy and its treatment. Effective pharmacological or surgical treatment may reduce illness intrusiveness in epilepsy. Findings also offer encouragement that QOL in epilepsy, as in other chronic conditions, may be enhanced by multidisciplinary bio-psychosocial efforts. Health care providers should consider multifaceted interventions to reduce illness intrusiveness and, thereby, improve QOL.     

Psychological factors and use of antiepileptic drugs: pilot work using an objective measure of adherence

Given the current emphasis on the "concordance" prescribing model, a study was designed to determine the influence of patients' beliefs about epilepsy, beliefs about medication and a range of neuroepilepsy variables on drug adherence among a sample of epilepsy patients. A special feature of the study was the use of a credible objective measure of drug adherence. Psychological health was also assessed. Thirty-seven patients were recruited from a local epilepsy clinic. Beliefs about epilepsy (illness representations), beliefs about epilepsy medication, anxiety, depression, neuroepilepsy status and adherence were all measured. Data were collected via clinical interview and questionnaire methods. Adherence with drug treatment was determined by an objective measure using low-dose phenobarbital as an indicator of adherence and, or, measurement of antiepileptic drug levels. Neither illness representations nor beliefs about epilepsy drugs were related to adherence. With the exception of time since last seizure, which was positively related to adherence, neuroepilepsy variables were unrelated to adherence. A number of significant associations between cognitive representations of epilepsy and mood were found.     

Toxic "atrophie cerebelleuse". (problems associated with permanent cerebellar damage due to chronic diphenylhydantion intoxication)

The authors report two cases with roentgenomophologically established cerebellar atrophy caused by chronic diphenylhydantoin overdosing. Exact neuropsychiatric testing of epileptics treated with diphenylhydantoin for a long period of time is demanded, and it is recommended that in the case of long-time therapy a maximum daily dose of 0.3 g of diphenylhydantoin be not exceeded.     

Conditional reflexes and sensory-evoked epilepsy: The nature of the therapeutic process

Studies of conditional reflex therapy for patients with sensory-evoked epilepsy are reviewed and experimental studies in animals reported. The behavioral methods employed in the therapy are reviewed. They are of a conditioning nature and are defined as clinical therapeutic conditioning. Sensory-evoked epilepsy can be induced in animals by conditioning techniques, provided the animal brain has been rendered epileptogenic. Sensory-evoked epilepsy in patients can be made worse by conditioning, and can be changed from one type to another. However, sensory-evoked seizures in humans are not the result of conditional reflexes.     

Some aspects of the management of patients with epilepsy in pregnancy

The care of pregnant epileptics calls for a high measure of personal attention and material expenditure. Above all, it means close cooperation between the epileptic specialist, the obstetrician, and the clinical pharmacologist. The need for this collaboration, and its effectiveness, are demonstrated by means of practical examples, with special consideration of blood level.     

Neurocognitive functioning of preschool children with uncomplicated epilepsy

Only few studies are available on the cognitive functioning of preschool children with uncomplicated epilepsy. The aim of this study was to describe the neurocognitive functioning of 3–6-year-old children with uncomplicated epilepsy. A subgroup of children with uncomplicated epilepsy from a population based cohort of preschool children with active epilepsy (N = 64) participated in the study. The neurocognitive functioning of these children (N = 13) was compared to that of matched healthy controls (N = 13). The Wechsler's Primary and Preschool Scale of Intelligence - Revised and the Developmental Neuropsychological Assessment were administered. The intellectual functioning of the children with uncomplicated epilepsy was within normal range, but differed significantly from that of healthy controls, which was contrary to expectations. Statistically significant differences emerged between the study and the control group in Verbal IQ and Full Scale IQ, but no differences were found in Performance IQ. The children with uncomplicated epilepsy also had minor neurocognitive difficulties in verbal short-term memory (p <.01) compared to healthy children. The result suggests that uncomplicated epilepsy in preschool children may interfere with language and verbal short-term memory functions. Further studies with detailed neuropsychological assessments and follow-up time are needed to gain more insight into the developmental course of children with uncomplicated epilepsy. Also, because of the developmental risks reported in this study, psychological screening and detailed neuropsychological assessment are recommended in clinical practice.     

Childhood epilepsy and the role of psychology.

The relatively long history of psychology's involvement in the field of epilepsy is discussed. The view of epilepsy is that of a chronic disorder with onset in childhood, at a time when normal development is at risk for interference from the direct and secondary aspects of repetitive seizures, the neurological abnormalities from which they arise, and the clinical interventions that attempt to control them. The objective and scientifically based methods of psychology are viewed as particularly well suited to these topics. Past efforts by psychologists have increased understanding of the syndrome that is epilepsy, and have paved the way for opportunities to further contribute to the theoretically and practically important problems associated with epilepsy.     

Is Speech Arrest during Wada Testing a Valid Method for Determining Hemispheric Representation of Language?

Background and objective: The intracarotid amobarbital procedure, or Wada test, is the method of choice to determine hemispheric representation of language, and is routinely used in the presurgical evaluation for intractable epilepsy. Some investigators perform comprehensive language assessments, but others base language lateralization solely on speech arrest. This study sought to determine whether speech arrest alone during Wada testing provides valid data regarding language lateralization. Methods: The subjects (previously reported) were 21 patients evaluated for intractable epilepsy, who underwent language lateralization by Wada testing and functional MRI (FMRI). For each patient, language representation was determined by calculating: (1) a Wada laterality index based exclusively on speech arrest; (2) a Wada laterality index based on comprehensive language assessment; and (3) an FMRI laterality quotient. Correlation coefficients and categorical classifications were analyzed. Results: There was no significant correlation between the Wada laterality quotient derived from duration of speech arrest and either the comprehensive Wada language laterality score (r= .35,p= .12) or FMRI language laterality score (r= .32,p= .16). Categorical classification as left, right or bilateral language also showed marked discordance between speech arrest and the other two methods. Conclusion: Duration of speech arrest during Wada testing is not a valid measure of language dominance.     

对癫痫的认识及其外科治疗

人们对癫痫的认识及其外科治疗的发展是一个漫长而复杂的过程,经历高潮、低谷的更迭。科技进步使人们对癫痫正确认识,也使治疗手段更趋于多样化、个性化。