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1.
Klin Padiatr ; 228(6-07): 286-293, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27846658

ABSTRACT

Survival rates have been excellent in patients treated for Hodgkin lymphoma (HL) during childhood and adolescence. Unfortunately, severe treatment related late effects have been observed. It was therefore an important aim of the cooperative pediatric HL therapy studies in Germany to reduce the number of late effects without jeopardizing the excellent treatment results. Progress and relapses of HL were analyzed to obtain important information for the future salvage therapy. All late effects were documented and their etiologies analyzed. Information obtained from bacterial infections and late deaths following splenectomy were used to inform patients at risk and their local physicians about necessary preventive measurements. Procarbazine was recognized as major gonadotoxic agent in boys and eliminated successively from the treatment regimens. Parenthood was normal in female patients when compared to the German female population documenting normal ovarian function except in patients with pelvic radiation. Radiation was the most important risk factor for thyroid diseases, cardiac late effects and subsequent malignant neoplasms, especially thyroid and breast cancer. A special screening program was initiated for women with chest radiotherapy, since they had a high risk of breast cancer already at a young age. The results of the HL Late Effects Research Project are important for the aftercare of patients and for the design of future HL treatment regimens.


Subject(s)
Combined Modality Therapy/adverse effects , Hodgkin Disease/therapy , Adolescent , Child , Early Detection of Cancer , Heart/radiation effects , Hodgkin Disease/mortality , Humans , Neoplasms, Radiation-Induced/etiology , Neoplasms, Radiation-Induced/prevention & control , Opportunistic Infections/etiology , Procarbazine/adverse effects , Procarbazine/therapeutic use , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Risk Factors , Salvage Therapy/adverse effects , Splenectomy/adverse effects , Survival Rate , Treatment Outcome
2.
Pneumologie ; 66(2): 89-95, 2012 Feb.
Article in German | MEDLINE | ID: mdl-22337328

ABSTRACT

Tyrosine kinase inhibition (TKI) such as erlotinib is a well established treatment option in the palliative care of patients with non small cell lung cancer (NSCLC). Histology and sex have been associated with different prognostic outcome measures in patients treated with erlotinib. Furthermore, the degree of rash, developed during treatment might be a relevant marker in respect to tumor response. To dissect these clinical relevant features we analysed a cohort of 275 patients treated with erlotinib in different lines of chemotherapy in our hospital. Nutrition status plays an important role in the prognosis of patients in a palliative chemotherapeutic setting, we therefore included body mass index measurements (BMI) in our analysis. We found that BMI and smoking status influence different survival patterns. Male patients have a poorer survival based on low BMI, rash development and smoking status. We therefore conclude that both nutritional and smoking status should be taken into account in the surveillance of patients with NSCLC in a palliative therapeutic setting under TKI treatment.


Subject(s)
Antineoplastic Agents/adverse effects , Body Mass Index , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Drug Eruptions/diagnosis , Exanthema/chemically induced , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Protein Kinase Inhibitors/administration & dosage , Quinazolines/adverse effects , Adenocarcinoma/drug therapy , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Aged , Antineoplastic Agents/therapeutic use , Body Height , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Cohort Studies , Drug Eruptions/mortality , Erlotinib Hydrochloride , Exanthema/diagnosis , Exanthema/mortality , Female , Humans , Lung Neoplasms/mortality , Male , Middle Aged , Neoplasm Metastasis/drug therapy , Neoplasm Metastasis/pathology , Palliative Care , Prognosis , Protein Kinase Inhibitors/therapeutic use , Quinazolines/therapeutic use , Retrospective Studies , Sex Factors , Smoking/adverse effects , Smoking/mortality , Statistics as Topic , Survival Analysis
3.
Brain Struct Funct ; 216(2): 137-49, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21153903

ABSTRACT

The insula is the fifth lobe of the brain and it is the least known. Hidden under the temporal, frontal and parietal opercula, as well as under dense arterial and venous vessels, its accessibility is particularly restricted. Functional data on this region in humans, therefore, are scarce and the existing evidence makes conclusions on its functional and somatotopic organization difficult. 5 patients with intractable epilepsy underwent an invasive presurgical evaluation with implantation of diagnostic invasive-depth electrodes, including insular electrodes that were inserted using a mesiocaudodorsal to laterorostroventral approach. Altogether 113 contacts were found to be in the insula and were stimulated with alternating currents during preoperative monitoring. Different viscerosensitive and somatosensory phenomena were elicited by stimulation of these electrodes. A relatively high density of electrode contacts enabled us to delineate several functionally distinct areas within the insula. We found somatosensory symptoms to be restricted to the posterior insula and a subgroup of warmth or painful sensations in the dorsal posterior insula. Viscerosensory symptoms were elicited by more anterior electrode contacts with a subgroup of gustatory symptoms occurring after stimulation of electrode contacts in the central part of the insula. The anterior insula did not show reproducible responses to stimulation. In line with previous studies, we found evidence for somato- and viscerosensory cortex in the insula. In addition, our results suggest that there is a predominantly posterior and central distribution of these functions in the insular lobe.


Subject(s)
Brain Mapping/methods , Cerebral Cortex/anatomy & histology , Cerebral Cortex/physiology , Epilepsy/physiopathology , Sensation/physiology , Adult , Analysis of Variance , Deep Brain Stimulation/methods , Electrodes, Implanted , Electroencephalography/methods , Female , Humans
4.
J Neurol Neurosurg Psychiatry ; 80(6): 683-5, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19448095

ABSTRACT

Electrophysiological studies in primates indicate that the eye fields of the cerebral hemispheres control gaze in three-dimensional space, and contain neurons that encode both conjugate (versive) and vergence eye movements. Two patients with epilepsy who exhibited disconjugate contraversive horizontal eye movements are described, one during electrical stimulation of the frontal eye fields and the other during focal seizures. We postulate that these eye movements resulted from combined contralateral version and vergence, and suggest that human cortical eye fields also govern visual search in a three-dimensional world, shifting the point of fixation between targets lying in different directions and at different depths.


Subject(s)
Convergence, Ocular/physiology , Depth Perception/physiology , Epilepsies, Partial/physiopathology , Eye Movements/physiology , Fixation, Ocular/physiology , Frontal Lobe/physiopathology , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Adult , Brain Mapping , Dominance, Cerebral/physiology , Electric Stimulation , Humans , Male , Orientation/physiology , Pursuit, Smooth/physiology , Saccades/physiology , Temporal Lobe/physiopathology
5.
Neurology ; 71(20): 1621-7, 2008 Nov 11.
Article in English | MEDLINE | ID: mdl-19001252

ABSTRACT

BACKGROUND: Dejerine and Benson and Geschwind postulated disconnection of the dominant angular gyrus from both visual association cortices as the basis for pure alexia, emphasizing disruption of white matter tracts in the dominant temporooccipital region. Recently functional imaging studies provide evidence for direct participation of basal temporal and occipital cortices in the cognitive process of reading. The exact location and function of these areas remain a matter of debate. OBJECTIVE: To confirm the participation of the basal temporal region in reading. METHOD: Extraoperative electrical stimulation of the dominant hemisphere was performed in three subjects using subdural electrodes, as part of presurgical evaluation for refractory epilepsy. RESULTS: Pure alexia was reproduced during cortical stimulation of the dominant posterior fusiform and inferior temporal gyri in all three patients. Stimulation resulted in selective reading difficulty with intact auditory comprehension and writing. Reading difficulty involved sentences and words with intact letter by letter reading. Picture naming difficulties were also noted at some electrodes. This region is located posterior to and contiguous with the basal temporal language area (BTLA) where stimulation resulted in global language dysfunction in visual and auditory realms. The location corresponded with the visual word form area described on functional MRI. CONCLUSION: These observations support the existence of a visual language area in the dominant fusiform and occipitotemporal gyri, contiguous with basal temporal language area. A portion of visual language area was exclusively involved in lexical processing while the other part of this region processed both lexical and nonlexical symbols.


Subject(s)
Dyslexia/etiology , Electric Stimulation/adverse effects , Reading , Temporal Lobe/physiology , Temporal Lobe/radiation effects , Brain Mapping , Comprehension/physiology , Comprehension/radiation effects , Dose-Response Relationship, Radiation , Dyslexia/pathology , Electrodes , Functional Laterality , Humans , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging , Neuropsychological Tests , Speech/radiation effects
6.
Nervenarzt ; 77(8): 961-9, 2006 Aug.
Article in German | MEDLINE | ID: mdl-16821062

ABSTRACT

The recent proposal by the ILAE Task Force for Epilepsy Classification is a multiaxial, syndrome-oriented approach. Epilepsy syndromes--at least as defined by the ILAE Task Force--group patients according to multiple, usually poorly defined parameters. As a result, these syndromes frequently show significant overlap and may change with patient age. We propose a five-dimensional and patient-oriented approach to epilepsy classification. This approach shifts away from syndrome orientation, using independent criteria in each of the five dimensions similarly to the diagnostic process in general neurology. The main dimensions of this new classification consist of (1) localizing the epileptogenic zone, (2) semiology of the seizure, (3) etiology, (4) seizure frequency, and (5) related medical conditions. These dimensions characterize all information necessary for patient management, are independent parameters, and include information more pertinent than the ILAE axes with regard to patient management. All cases can be classified according to this five-dimensional system, even at initial encounter when no detailed test results are available. Information from clinical tests such as MRI and EEG are translated into the best possible working hypothesis at the time of classification, allowing increased precision of the classification as additional information becomes available.


Subject(s)
Epilepsy/classification , Epilepsy/diagnosis , Practice Guidelines as Topic , Terminology as Topic , Humans , International Agencies
7.
Neurology ; 66(12): 1938-40, 2006 Jun 27.
Article in English | MEDLINE | ID: mdl-16801667

ABSTRACT

To assess short- and long-term seizure freedom, the authors reviewed 371 patients who underwent anterior temporal lobectomy to treat pharmacoresistant epilepsy. The mean follow-up duration was 5.5 years (range 1 to 14.1 years). Fifty-three percent of patients were seizure free at 10 years. The authors identified multiple predictors of recurrence. Results of EEG performed 6 months postoperatively correlated with occurrence and severity of seizure recurrence, in addition to breakthrough seizures with discontinuation of antiepileptic drugs.


Subject(s)
Anterior Temporal Lobectomy/statistics & numerical data , Epilepsy/diagnosis , Epilepsy/surgery , Outcome Assessment, Health Care/methods , Proportional Hazards Models , Risk Assessment/methods , Severity of Illness Index , Anticonvulsants/therapeutic use , Chronic Disease , Epilepsy/drug therapy , Epilepsy/epidemiology , Humans , Incidence , Prognosis , Reproducibility of Results , Retrospective Studies , Risk Factors , Secondary Prevention , Sensitivity and Specificity , Temporal Lobe/surgery , Treatment Failure , Treatment Outcome , United States/epidemiology
10.
J Neurol Neurosurg Psychiatry ; 76(5): 710-3, 2005 May.
Article in English | MEDLINE | ID: mdl-15834032

ABSTRACT

OBJECTIVE: To determine outcome after epilepsy surgery in patients with normal preoperative magnetic resonance imaging (MRI). METHODS: 24 adult and paediatric patients with normal preoperative MRIs were studied. They underwent epilepsy surgery between 1994 and 2001 and had at least one year of follow up. RESULTS: At the most recent follow up, nine patients (37%) were seizure-free and 18 (75%) had at least a 90% reduction in seizure frequency with weekly or monthly seizures. Seizure freedom was not significantly different after resections in frontal (5/9) or temporal regions (4/13) (p = 0.24, Fisher's exact test), or among patients with or without localising features on EEG, PET, or ictal SPECT. Subdural grids, used in 15 of 24 patients, helped tailor resections but were not associated with differences in outcome. Histopathology showed cortical dysplasia in 10 patients (42%), non-specific findings in 13 (54%), and hippocampal sclerosis in one (4%). Cortical dysplasia was seen in seven patients with frontal resection (78%) and non-specific findings in nine (69%) with temporal resection. Seizure outcome did not differ on the basis of location of resection or histopathology. CONCLUSIONS: While these results were less favourable than expected for patients with focal epileptogenic lesions seen on MRI, they represented worthwhile improvement for this patient population with high preoperative seizure burden. In this highly selected group, no single test or combination of tests further predicted postoperative seizure outcome.


Subject(s)
Brain/pathology , Brain/surgery , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/surgery , Magnetic Resonance Imaging , Preoperative Care , Adolescent , Adult , Brain/blood supply , Child , Child, Preschool , Electroencephalography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Positron-Emission Tomography , Tomography, Emission-Computed, Single-Photon , Treatment Outcome
11.
Epilepsy Behav ; 5(6): 1021-3, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15582855

ABSTRACT

Although there is a peak in the incidence of epilepsy in the elderly compared with the general population, complex partial seizures represent less than 15% of the seizure types reported. We report on a 92-year-old woman with a 2-year history of daily complex partial seizures. Prolonged video/EEG recording showed bilateral anterior mesial temporal interictal spikes, which predominated on the left, and two typical seizures arising from the left temporal area. Cranial MRI scanning showed multiple lacunar infarcts without temporal lobe involvement or mesial temporal atrophy. Our case appears to be oldest patient in the literature with newly diagnosed mesial temporal lobe epilepsy confirmed by video/EEG recording.


Subject(s)
Electroencephalography , Epilepsy, Temporal Lobe/physiopathology , Age of Onset , Aged , Aged, 80 and over , Electromyography/methods , Epilepsy, Temporal Lobe/diagnosis , Female , Functional Laterality/physiology , Humans , Magnetic Resonance Imaging/methods
12.
J Neurol Neurosurg Psychiatry ; 75(6): 879-83, 2004 Jun.
Article in English | MEDLINE | ID: mdl-15146005

ABSTRACT

BACKGROUND: Piloerection is a rare clinical symptom described during seizures. Previous reports suggested that the temporal lobe is the ictal onset zone in many of these cases. One case series concluded that there is a predominant left hemispheric representation of ictal cold. The aim of this study is to evaluate the localising and lateralising value of pilomotor seizures. METHODS: Medical records of patients who underwent video electroencephalogram (EEG) monitoring at the Cleveland Clinic between 1994 and 2001 were reviewed for the presence of ictal piloerection. The clinical history, physical and neurological examination, video EEG data, neuroimaging data, cortical stimulation results, and postoperative follow ups were reviewed and used to define the epileptogenic zone. Additionally, all previously reported cases of ictal piloerection were reviewed. RESULTS: Fourteen patients with ictal piloerection were identified (0.4%). Twelve out of 14 patients had temporal lobe epilepsy. In seven patients (50%), the ictal onset was located in the left hemisphere. Four out of five patients with unilateral ictal piloerection had ipsilateral temporal lobe epilepsy as compared with the ipsilateral side of pilomotor response. Three patients became seizure free after left temporal lobectomy for at least 12 months of follow up. An ipsilateral left leg pilomotor response with simultaneously recorded after-discharges was elicited in one patient during direct cortical stimulation of the left parahippocampal gyrus. CONCLUSIONS: Ictal piloerection is a rare ictal manifestation that occurs predominantly in patients with temporal lobe epilepsy. Unilateral piloerection is most frequently associated with ipsilateral focal epilepsy. No hemispheric predominance was found in patients with bilateral ictal piloerection.


Subject(s)
Brain Mapping/methods , Functional Laterality/physiology , Piloerection/physiology , Seizures/diagnosis , Adolescent , Adult , Electroencephalography/methods , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Seizures/physiopathology , Seizures/surgery , Temporal Lobe/physiopathology , Temporal Lobe/surgery , Videotape Recording
13.
Neurology ; 62(10): 1729-35, 2004 May 25.
Article in English | MEDLINE | ID: mdl-15159469

ABSTRACT

BACKGROUND: Recent MRI-based volume reconstruction studies in intractable temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) suggested atrophy that extends to the adjacent neocortical areas. OBJECTIVE: To study the extent of temporal lobe volume (TLV) abnormalities in patients with pathologically confirmed HS (with or without cortical dysplasia [CD]) who underwent anterior temporal lobectomy for the treatment of drug-resistant TLE. METHODS: Fifty patients (right TLE: n = 24; left TLE: n = 26) were found to have HS (hippocampal cell loss of >30%). Associated neocortical CD was seen in 20 patients (43%). MRI-based TLVs and hippocampal and hemispheric volume reconstructions in all patients were compared between pathologic groups and with volumes acquired from 10 age-matched control subjects. RESULTS: TLVs ipsilateral to the epileptogenic zone in patients with TLE were smaller than TLVs in control subjects (p < 0.01). In patients with left TLE, TLVs ipsilateral to the epileptogenic zone were smaller than contralateral TLVs (left: 66.6 +/- 8.3 cm3, right: 74.9 +/- 10.0 cm3; p < 0.001). In patients with right TLE, there were no significant asymmetries. The contralateral TLVs (regardless of the side of surgery) were smaller in the HS + CD group than the HS group (HS + CD group: 74.9 +/- 8.6 cm3, HS group: 79.7 +/- 6.6 cm3; p < 0.05). Patients with HS + CD had a tendency to have less hippocampal atrophy and slightly smaller TLVs ipsilateral to the epileptogenic zone, accounting for significantly smaller TLV/hippocampal volume ratios compared with patients with HS alone. CONCLUSIONS: Drug-resistant TLE due to HS is associated with extrahippocampal temporal lobe atrophy. The presence of bilateral temporal lobe atrophy is suggestive of a more widespread (bilateral) temporal lobe involvement in patients with HS and CD.


Subject(s)
Cerebral Cortex/abnormalities , Hippocampus/pathology , Temporal Lobe/pathology , Adolescent , Adult , Anterior Temporal Lobectomy , Anticonvulsants/pharmacology , Anticonvulsants/therapeutic use , Atrophy , Cell Count , Child , Combined Modality Therapy , Drug Resistance , Epilepsy, Temporal Lobe/drug therapy , Epilepsy, Temporal Lobe/pathology , Epilepsy, Temporal Lobe/surgery , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurons/pathology , Organ Size , Sclerosis
14.
Neurology ; 62(6 Suppl 3): S2-8, 2004 Mar 23.
Article in English | MEDLINE | ID: mdl-15037671

ABSTRACT

BACKGROUND: There have been difficulties in achieving a uniform terminology in the literature regarding issues of classification with respect to focal cortical dysplasias (FCDs) associated with epilepsy. OBJECTIVE: S: To review and refine the current terminology and classification issues of potential clinical relevance to epileptologists, neuroradiologists, and neuropathologists dealing with FCD. METHODS: A panel discussion of epileptologists, neuropathologists, and neuroradiologists with special expertise in FCD was held. RESULTS: The panel proposed 1) a specific terminology for the different types of abnormal cells encountered in the cerebral cortex of patients with FCD; 2) a reappraisal of the different histopathologic abnormalities usually subsumed under the term "microdysgenesis," and suggested that this terminology be abandoned; and 3) a more detailed yet straightforward classification of the various histopathologic features that usually are included under the heterogeneous term of "focal cortical dysplasia." CONCLUSION: The panel hopes that these proposals will stimulate the debate toward more specific clinical, imaging, histopathologic, and prognostic correlations in patients with FCD associated with epilepsy.


Subject(s)
Brain Diseases/classification , Cerebral Cortex/abnormalities , Cerebral Cortex/pathology , Nervous System Malformations/classification , Terminology as Topic , Brain Diseases/complications , Brain Diseases/pathology , Epilepsy/complications , Humans , Nervous System Malformations/complications , Nervous System Malformations/pathology , Neurons/pathology
15.
Epilepsy Res ; 56(2-3): 83-4, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14642991

ABSTRACT

The Third International Spring Epilepsy Research Conference took place in Georgetown, Cayman Islands from April 26 to May 3, 2003. One workshop discussed the impact of epilepsy surgery on seizure outcome and mortality of antiepileptic drug (AED)-resistant temporal lobe epilepsy. This article summarizes the information presented at this workshop. Although two-thirds of adult patients undergoing epilepsy surgery become seizure-free with continued AED treatment, current clinical experience shows that seizure recurrence occurs in one-third of patients when AEDs are withdrawn under medical supervision. Additional seizure recurrence occurring after AED taper, poor drug compliance and even while patients continue on AEDs after surgery leave only approximately one-third of patients cured after temporal lobe resection. Mostly because so many patients prefer to stay on AEDs although they are free of disabling seizures after surgery, a randomised controlled trial of AED discontinuation is needed to determine if in fact only one-third of patients are cured after surgery. Based on the functional anatomy of temporal lobe surgery two hypotheses are presented why only a minority of patients are cured after surgery. The type and the prognostic significance of seizures after surgery is discussed. Recent studies have suggested that successful temporal lobe surgery may be able to normalize the increased standard mortality ratio (SMR) of drug-resistant temporal lobe epilepsy. However, pre-existing differences in SMR between those cured and those not cured by temporal lobe surgery and other unresolved methodological issues make it difficult at present to fully evaluate the impact of surgery on mortality. Future studies are thus warranted to specifically address the impact of temporal lobe surgery on cure and mortality.


Subject(s)
Epilepsy/mortality , Epilepsy/surgery , Temporal Lobe/surgery , Drug Resistance , Humans , Treatment Outcome
16.
Onkologie ; 26(5): 489-93, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14605468

ABSTRACT

The prognosis for children and adolescents with Hodgkin's lymphoma is excellent. However, many patients will show secondary malignancies 15-30 years after the initial diagnosis, which appears to be connected with the intensity of treatment during primary disease. In the GPOH-HD 95 trial, the indication for radiotherapy was limited to patients who did not show a complete remission after chemotherapy, as determined radiographically. In the future protocol, the indication for radiotherapy in patients with early-stage Hodgkin's lymphoma should be further refined by using FDG-PET for evaluating the response to chemotherapy. Furthermore, in patients at an advanced stage of the disease, it should be determined if sequential FDG-PET research during chemotherapy can separate patients into subgroups with an excellent or a poor prognosis. This article gives a review of the current literature on FDG-PET in patients with Hodgkin's lymphoma and outlines the consequences for future protocols.


Subject(s)
Blood Glucose/metabolism , Hodgkin Disease/pathology , Neoplasm, Residual/pathology , Tomography, Emission-Computed , Adolescent , Child , Combined Modality Therapy , Disease-Free Survival , Fluorodeoxyglucose F18 , Follow-Up Studies , Hodgkin Disease/diagnostic imaging , Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Humans , Neoplasm Staging , Neoplasm, Residual/diagnostic imaging , Neoplasm, Residual/drug therapy , Neoplasm, Residual/radiotherapy , Prognosis , Radiotherapy, Adjuvant , Sensitivity and Specificity , Treatment Outcome , Whole-Body Counting
17.
Nervenarzt ; 74(8): 664-76, 2003 Aug.
Article in German | MEDLINE | ID: mdl-12904868

ABSTRACT

Attempts to control epileptic seizures by electrical brain stimulation have been performed for 50 years. Many different stimulation targets and methods have been investigated. Vagal nerve stimulation (VNS) is now approved for the treatment of refractory epilepsies by several governmental authorities in Europe and North America. However, it is mainly used as a palliative method when patients do not respond to medical treatment and epilepsy surgery is not possible. Numerous studies of the effect of deep brain stimulation (DBS) on epileptic seizures have been performed and almost invariably report remarkable success. However, a limited number of controlled studies failed to show a significant effect. Repetitive transcranial magnetic stimulation (rTMS) also was effective in open studies, and controlled studies are now being carried out. In addition, several uncontrolled reports describe successful treatment of refractory status epilepticus with electroconvulsive therapy (ECT). In summary, with the targets and stimulation parameters investigated so far, the effects of electrical brain stimulation on seizure frequency have been moderate at best. In the animal laboratory, we are now testing high-intensity, low-frequency stimulation of white matter tracts directly connected to the epileptogenic zone (e.g., fornix, corpus callosum) as a new methodology to increase the efficacy of DBS ("overdrive method").


Subject(s)
Electric Stimulation/methods , Electroconvulsive Therapy/methods , Epilepsy/therapy , Magnetics/therapeutic use , Palliative Care/methods , Clinical Trials as Topic , Epilepsy/prevention & control , Humans , Seizures/prevention & control , Seizures/therapy , Treatment Outcome
18.
Klin Padiatr ; 215(3): 139-45, 2003.
Article in English | MEDLINE | ID: mdl-12838937

ABSTRACT

BACKGROUND: In 5 consecutive pediatric and adolescent Hodgkin's disease trials DAL-HD since 1978 the invasive diagnostic procedures and the radiotherapy have gradually been reduced and chemotherapy modified to minimize toxicity and the risk of late effects. Since 1982 the overall survival increased up to 95%. In this trial the possibility of reducing local radiation doses to 20 Gy in patients with good response to chemotherapy and omitting radiotherapy totally for patients with complete remission after chemotherapy was tested. PATIENTS AND METHODS: Over a period of 6 years, from August 1995 to July 2001, 1018 children and adolescents with Hodgkin's disease from Germany, Austria,Switzerland, the Netherlands, Sweden, Norway and Denmark were enrolled in this trial. The chemotherapy was equivalent to previous trial DAL-HD 90. The treatment group (TG) 1 (stages I and IIA) received 2 cycles OPPA for girls and 2 cycles OEPA for boys, TG2 (stages IIEA, IIB, IIIA) and TG3 (stages IIEB, IIIEA, IIIB, IV) received additional 2 or 4 cycles COPP respectively. In contrast to trial DAL-HD 90 boys in stage IIIB and IIIEB received OPPA instead of OEPA. The initial staging as well as the restaging for evaluating tumor volume reduction after chemotherapy was reviewed by the study center. Radiotherapy was planned accordingly: patients with complete remission after chemotherapy were not irradiated (21.9%); all other patients received local radiotherapy to the initially involved sites, depending on the tu-mor response. Patients with a partial remission of> 75 tumor regression were irradiated with 20 Gy (50AX), partial remission of< 75% with 30 Gy (4.1 %), and residual masses of > 50 ml were boosted up to 35 Gy (20.2 %). RESULTS: 36 tumor progressions and 49 relapses occurred over a period of 7 1/2 years (median followup 3 years, data deadline 12/19/02). Kaplan-Meier-analysis after 5 years showed a probability for event-free survival (pEFS) for all patients of 0.88 and for overall survival (pOS) of 0.97. For the total group the pDFS (disease free survival) was lower in 222 non irradiated patients than in the 758 irradiated patients (0.88 vs. 0.92,p - 0.049). But there was a difference between the individual treatment groups. In TG 1 there was no difference between nonirradiated and irradiated patients (0.97 vs. 0.94) and the non-ir-radiated patients showed a better trend. In TG 2, and in TG 2 and TG 3 combined, the pDFS was significantly worse for non irradiated patients in comparison with the irradiated patients (TG2:0.78 vs. 0.92; TG 2 +3:0.79 vs. 0.91). Compared to former DAL-HD trials the pOS stayed stable despite therapy reduction. CONCLUSIONS: A reduction of radiotherapy to 20 Gy for patients in all stages with good response to chemotherapy is possible without deterioration of the results. The omission of radiotherapy for patients in complete remission after chemotherapy is recommended only for patients in early stages (TG1). In future trials the possibility of a wider selection for chemotherapy alone for this group needs to be evaluated. In intermediate (TG2) and advanced (TG3) stages omission of radiotherapy for patients incomplete remission results in a lower pEFS, but the pOS is not significantly reduced. Only with knowledge of the long term effects of today's therapy we can give a satisfactory answer to the question whether in future trials the primary aim should be pEFS as high as possible due to front-line-therapy or reduction of late effects.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hodgkin Disease/drug therapy , Adolescent , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Child , Child, Preschool , Combined Modality Therapy , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Drug Administration Schedule , Etoposide/administration & dosage , Etoposide/adverse effects , Europe , Female , Hodgkin Disease/mortality , Hodgkin Disease/pathology , Hodgkin Disease/radiotherapy , Humans , Male , Neoplasm Staging , Prednisone/administration & dosage , Prednisone/adverse effects , Procarbazine/administration & dosage , Procarbazine/adverse effects , Radiotherapy, Adjuvant , Survival Rate , Vincristine/administration & dosage , Vincristine/adverse effects
19.
Klin Padiatr ; 215(3): 146-50, 2003.
Article in German | MEDLINE | ID: mdl-12778354

ABSTRACT

Today no evidence based medicine analyses exist about the value of positron emission tomography (PET) in children and adolescents with Morbus Hodgkin. The increasing number of registered PET-examinations within the scope of the GPOH-HD 95 trial motivated to analyse the validity of 18-FDG-PET-examination findings in comparison to the conventional diagnostic methods (CT/MRI/ultrasound) and to the patients follow up. 67 PET-primary staging findings and 48 PET-follow up findings of altogether 106 patients from 27 PET-centres were analysed. Concerning the primary staging findings a concordance of 92% of the PET-findings and the findings of the CT/MRI/ultrasound-examinations per localisation was found, but in more than 50% of the patients a discrepancy occurred in at least one of the 9 investigated localisations. The analysis of the PET follow up findings showed a negative predictive value of 94% in regularly examinations (without previous suspicion of relapse), but only a positive predictive value of 25%. In case of relapse suspicion there was a negative predictive value of 83% and a positive predictive value of 76% in PET. A good prognosis is possible to predict from negative PET follow up findings (relapse risk in regularly controls 7%, at relapse suspicion 17%), whereas the probability for a true relapse in positive PET follow up findings is only markedly increased in case of former relapse suspicion (relapse risk in regularly controls 25%, at relapse suspicion 82%). A prospective multicenter PET study should be realized to analyse systematically the value of PET diagnostics in staging and restaging examinations of children and adolescents with Hodgkin's disease, especially to validate the PET diagnostics in exclusion of vital tumor residuals.


Subject(s)
Blood Glucose/metabolism , Energy Metabolism/physiology , Hodgkin Disease/diagnostic imaging , Tomography, Emission-Computed , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Child , Child, Preschool , Europe , Female , Fluorodeoxyglucose F18 , Follow-Up Studies , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Humans , Male , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Predictive Value of Tests , Retrospective Studies
20.
Neurology ; 60(5): 870-3, 2003 Mar 11.
Article in English | MEDLINE | ID: mdl-12629251

ABSTRACT

A patient with absence of the basal ganglia and refractory epilepsy without impairment of pyramidal or extrapyramidal motor function is reported. Imaging findings suggest a vascular insult as etiology. Preserved motor function could be explained by neuronal plasticity involving contralateral corticostriatal and pallidothalamic connections and points to a lesion received in early pregnancy.


Subject(s)
Basal Ganglia/abnormalities , Basal Ganglia/pathology , Epilepsies, Partial/etiology , Adolescent , Adult , Caudate Nucleus/abnormalities , Frontal Lobe/pathology , Globus Pallidus/abnormalities , Humans , Magnetic Resonance Imaging , Male , Putamen/abnormalities , Substantia Nigra/abnormalities , Subthalamic Nucleus/abnormalities , Tomography, Emission-Computed
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