[Long-term catamnesis on the topic of uses and side effects of lithium prevention of phasic psychoses]. / Langzeitkatamnese zur Frage von Nutzen und Nebenwirkungen der Lithiumprophylaxe der phasischen Psychosen.

A lithium long-term catamnesis of 124 patients (107 manic-depressive and 17 schizoaffective psychoses) after more than 8 years of lithium prophylaxis led to the following results: 1.) Recovering: 30.3%. Improvement - particularly mitigation of the episodes of illness -: 56%. Lack of efficiency: 13%. Mean incidence of episodes of illness before lithium 0.57 per year, during lithium 0.36. Mean incidence of hospitalisation before lithium 3.4 years, during Lithium 7.1 years. Deterioration following discontinuation of lithium: 21 of 22 cases. 2.) Side effects at the beginning: 61.2%, finally 42.7% (incidence of struma 19.5% of tremor 19%, of polydipsia/polyuria 9.1%). 3.) EEG changes (general slowing-down and dysrhythmia, to a quarter focally accentuated): 59%. 4.) Normal results of haematologic and clinical-chemical investigations (28 parameter) except serum creatinine (10%), creatinine clearance (20.5%) and leucocytosis (13%). The authors discuss the reduced incidence of recovery and the quantity of side effects based on the aspect of long-term catamnesis. Further studies are necessary with regard to the selection of lithium-treated patients, to the duration of prophylaxis without efficiency and to the shift from initial efficiency to later inefficiency.

Systematic EEG follow-up study of traumatic psychosis.

A systematic 2 year follow-up study of EEG in 100 patients suffering from traumatic psychosis with amnesia lasting more than 1 week led to the following results. (1) EEG foci were demonstrated in 95% of cases, and bilaterally in 70%. Normalization occurred within 3 months in 48% of patients, with foci persisting for more than 2 years in 22% mostly in patients with traumatic epilepsy. Focal signs initially consisted of delta foci (85%) and finally of focal dysrhythmia (72%), with temporal localization increasing from 58% to 82%. EEG foci were associated with neurological focal symptoms in 49% of cases and skull fractures in 78%. (2) During psychosis a general slowing of EEG was constantly observed. Normalization occurred within 3 months in 28% of patients. Rarely slowing lasted longer than 6 months. (3) It took longer to normalize general slowing than EEG foci, but slowing disappeared more completely. The left preponderance of EEG foci in traumatic psychosis could not be confirmed, the hypothesis of a pathoplastic role of the speech dominant hemisphere was not proved.

[Left-sided lateralisation and localisation of EEG foci in relation to age and diagnosis (author's transl)]. / Zur Frage der Alters- und Diagnoseabhängigkeit der Links-Lateralisation und Lokalisation von EEG-Herden.

The retrospective evaluation of seven non-selective random tests of a total of 2543 continuously registered EEG foci shows the following results: 1. EEG foci on the left side: 1532 = 63.6%; foci on the right side: 875 = 36.4%. 2. Left preponderance in all decennia, significant from the second decennium onwards in nearly constant measurement. 3. Of all foci, 43.6% were exclusively located in temporal regions (71% on the left, 29% on the right). The foci of the occipital region decreased from 60% to 20% between the first decennium and involution, the foci of the temporal region increased from 26% to 54%. 4. Left preponderance occurred in all kinds of EEG foci, among the delta-foci only because of their accumulation in the temporal region. 5. In all diagnoses, the left side was more frequently affected, most distinctly among vascular disturbances, least distinctly among intracranial space-occupying lesions. 6. Six of seven EEG examiners showed significant left preponderance. The extent of left preponderance and the frequency of reductions of alpha waves, of focal dysrhythmias, and of theta wave foci were dependent on the examiner. 7. The authors discuss the connection between the general left preponderance of EEG foci, which is modified by but not basically dependent on sex, age, and diagnosis, and the greater possibility of disturbing the function of the hemisphere dominating speech development.

[Lithium balance in mania]. / Untersuchungen zur Lithiumbilanz während der Manie.

Lithium balance studies were performed in 19 patients suffering from mania and 6 patients suffering from depression. The following results were obtained: (1) The mean daily requirement for lithium in the manic patients was 52 mM, in those with depression 30 mM (additional requirement in manic patients 73%). (2) Renal elimination of lithium, after optimal blood lithium levels had been reached, was 76% in mania and 97% in depression (retention in manic patients 21%). (3) In mania there was an unchanged lithium half-life time (12-13.5 h). (4) In mania and depression no significant differences in lithium and creatinine clearance were noted. (5) Standard diet or unrestricted sodium chloride administration did not significantly influence the lithium requirement or lithium retention. After exclusion of a renal or dietetic cause for increased lithium requirement or retention during mania, the existence of a 'lithium pool' dependent on the presence of a manic psychosis seems probable. As a result of this, somatic influences on endogenous psychosis have to be taken into account.

[Lithium balance in healthy volunteers]. / Untersuchungen zur Lithiumbilanz bei gesunden Probanden.

Lithium sulphate in a sustained-release preparation was given to three healthy volunteers during 10 days. The following results were obtained: 1. The daily requirement needed for maintenance of an efficient lithium serum level from 0.7 to 0.8 mmol/l amounts to 30 mval. A steady state level of the serum lithium concentration was achieved after 4 to 5 days. 2. The mean value of lithium clearance amounts to 26.8 ml/min. 3. Approx. 98% of the ingested lithium could be recovered from the urine. 4. 6 days after drug withdrawal the lithium concentration in serum and urine was determined as 0. This result shows that the study of lithium balance can rely on renal excretion excluding other pathways. It is discussed that the simultaneous ingestion of psychortropic drugs and sodium chloride may influence the elimination rate of lithium.

[Neurological and EEG-follow-up studies in head-injured adults: criteria for the clinical diagnosis concussion and contusion (author's transl)]. / Systematische klinische und EEG-Verlaufsuntersuchungen nach Schädeltraumen bei Erwachsenen: zum klinischen Begriff Commotio/Contusio cerebri.

A stystematic neurological and electroencephalographical follow-up study in 344 head injured adults gave the following results: 1. 52% of all the hospitalized (mostly primarily amnesic) patients had a cerebral contusion. A contusion was assumed in cases with focal neurological signs (13%), amnesias of more than 8 hours (16%) and/or EEG-abnormalities lasting for more than 24 hours (49%). 2. Traumatic EEG-abnormalities were general slowing (43%) and foci (32%). In 40% of the cases with general slowing the slowing (greater than or equal to 1.5/sec) was within the alpha-frequency band and could only retrospectively be assed. 3. The EEG was invariably abnormal in cases with an amnesia exceeding 8 hours. If the amnesia exceeded 1 hour abnormalities were found in 73%. 4. Among the patients with contusion 6.5% had no amnesia, 48% less than 30 minutes and only 30% an amnesia for more than 8 hours. In 75% of the patients with concussion amnesia lasted less than one hour. 5. Skull fractures were mostly combined with contusion (74%). 6. Impaired drive, reduced ability to concentrate, memory deficits, headache and dizziness were significantly more frequent 6 months after contusion than after concussion. 7. 21% of the patients with traumatic dizziness (44%) had a labyrinthine contusion. 8. Among the contusions diagnosed with the aid of EEG recordings 58% would have been missed after exclusive neurological examination and 82% after application of the classical criteria used by surgeons and general practitioners.

[Similarities and differences after head injuries in children and adults (author's transl)]. / Schädeltraumen bei Kindern und Erwachsenen. Gemeinsamkeiten und Unterschiede

The results of a systematic neurological and electro-encephalographical follow-up study in 344 head injured adults and 116 children were compared. The results show that posttraumatic EEG abnormalities lasting more than 24 hours, are equally frequent in children (53%) and in adults (49%). Mostly short lasting neurological signs of focal tissue damage are however significantly more frequent in children (30% vs. 13% and EEG-abnormalities (foci and general slowing) are on the average more pronounced. The recovery of EEG abnormalities follows the same pattern as in adults, occurs however faster among children. In both groups the normalization of general slowing precedes that of focal abnormalities only in 25% of the cases. Amnesias on the average last shorter in infants. Their duration seems of lesser significance for the judgement of the severity of the trauma in children than in adults. 6 months after the trauma children complain less frequently about headache, dizziness, or impaired memory and diminished ability to concentrate; emotional lability and impairement of drive, however, are more frequent than in adults. The results indicate an equal diagnostic and prognostic importance of systematic EEG studies (within 2 days, after 1 week and 6 month after the trauma) in both groups.

[Systematic follow up study of posttraumatic EEG-abnormalities in children (author's transl)]. / Systematische EEG-Längsschnittuntersuchungen in der akuten Phase des kindlichen Schädel-Hirntraumas

A systematic follow up study of EEG in 116 children, who after head injury were admitted to a surgical ward and examined within 3 days, the following day and the 30., 90., and 180. day after the trauma gave the following results; 1. EEG examinations indicate traumatic cerebral disturbances (foci 38%, general slowing 47%) nearly twice as often (53%) as neurological examination (30%). 2. 45% of the cases with general slowing may be detected by repeated examinations only because of the variability of the EEG in infancy. 3. Focal signs consisted mainly in delta-foci, in 74% of temporal localisation. S.c. reduction foci without slowing were not found. 4. Skull fractures were mostly combined with EEG changes (10 from 11). 5. Variations in vigilance were significantly more frequent in contusions in the initial stages, hyperventilation changes in the later stages. The reduction of amplitudes was without diagnostic relevance. 6. Normalization of slowing preceeded that of foci in only 23% although focal abnormalities persisted for more than 6 months in 14% and slowing only in 4%. 7. In 60% of the patients with traumatic EEG changes amnesia had not lasted longer than 10 minutes. Amnesias lasting more than 2 hours were always accompanied by EEG abnormalities. 8. Traumatic EEG abnormalities are not missed, if recordings are performed within 3 days and controlled 3 months after the trauma. The problem of the diagnostic classification is discussed and it is recommended, that the notion of contusion is used in a broader sense.