[Epilepsy and suicide--a new evaluation. Prevalence and classification of methods]. / Epilepsie und Suizidalität--eine Neubewertung. Häufigkeit und Methodenkritik.

According to a criticism of all findings results that an early and progressing successful medical and psychosocial therapy will help to reduce respectively to prevent suicide. Certainly the risk is still insignificant higher than on the average of general population but doesn't come to the three- or five-fold as constantly repeated in the past. The uncertain number of attempts of suicides is at least comparably high in epileptics and general population. The described facts give permission to more founded statements with respect to the prognosis of epilepsies and should be taken into consideration by contracting for life-insurances, especially if seizure-control persists or is to be expected within a reasonable space of time.

[Specialty clinics for epilepsies--a requirement in our time]. / Fachkliniken für Epilepsien--Eine Forderung unserer Zeit.

Explained are the reasons for the necessary establishing--for the present as a model. Projected is one clinical centre of over-regional importance (capacity: 200 admissions) for epileptic patients. Children, youth and adults, who are (sub-)acute ill, will be treated by means of a four to rather eight weeks program in order to obtain a medical and social (re-)habilitation. Their family members and/or partners might be involved. Prevention with respect to the development of chronic psychosyndromes causing premature disability and social disintegration is an essential task of this special clinic. Prepromotion to take up a profession may also be of importance. By this means the prognosis of epilepsies will be improved. Evaluation of psychotherapeutic findings is a part of necessary scientific work.

[Medical, psychosocial rehabilitation and prevention in patients with epilepsy]. / Midizinisch-psychosoziale Rehabilitation und Prävention bei Patienten mit Epilepsein.

Patients suffering from epilepsy and quite frequently reversible impairment of personality and individual development are in need of specific, disease-related measures of rehabilitation. Particularly, the complexity of the disorder prevents from a responsible and successful self-management. In order to obtain effective rehabilitation and reintegration into all aspects of social life it is essential to initiate a comprehensive treatment plan for the patients at the earliest possible stage considering personality, the distinct form of seizures, education and training as well as the condition of the environment. It requires various programs of precise examination and preventive treatment at specific facilities to ensure the desired success of rehabilitation. Thus multiple social disadvantages as well as unnecessary longterm costs may be avoided and mainly that kind of therapy will result in a better life quality and prolonged life expectancy for the epileptic patients.

[Psychoses in epilepsy]. / Psychosen bei Epilepsien.

The heterogenous psychoses in epilepsies, caused by well known conditions, are not rare but associated with regularly a few of seizure-types not with the nature and development of attacks. Polar transitional ranks and converging courses of schizophrenic (accentuated) syndromes in epilepsies and idiopathic schizophrenias are rather frequent. Also (sub-)acute schizophrenic psychoses are corresponding to the complete palette of first and second rank symptoms (K. Schneider) of idiopathic schizophrenias. After manifestations of epilepsy these syndromes can appear at any time. It is given a profile of risks. Progressive avoidance of a. phenylaceturea, b. mixtures of antiepileptics did not put an end to psychotic syndromes: Long-term therapies with 1. Polytherapy, 2. Primidone and Phenytoin (dosedependant) as well as 3. Ethosuximide (-monotherapy) cause a disorder of feed back mechanisms, especially a disturbed regulation of vigilance and sleeping-waking-cycle and their psychological correlates. Carbamazepine and Sodium Valproate are, plasma-level-controlled of preventive antipsychotic effect. Selected neuroleptics of rather slight epileptogenic potency are of going down importance. Benzodiazepines are required mostly in prepsychotic syndromes, Lithium compounds in selected cases. There is no more alternative seizures or psychosis.

Schizophrenic syndromes in epilepsies.

Following a historical review and critical appraisal of the literature (problems of definition, selection, frequency, etiology, relation and classification) clinical findings from a series of retrospective and prospective studies (four samples with altogether 47 epileptic patients) are presented and discussed, as well as the results of EEG, CT and other relevant investigations. (1) 'Schizophrenia-like' interictal (periictal) psychoses in the epilepsies, which are not rare, appear to be true schizophreniform (= schizophrenic-accentuated) syndromes in a setting of 'clear' consciousness. There is no case of alternative psychosis and EEG 'forced normalization'. (2) Between schizophrenic-accentuated syndromes associated with regularly symptomatic epilepsies and genuine (endogeneous) schizophrenias, there are quantitative but no qualitative differences. Often there is a congruence and no possibility of differentiating in the transverse study. This is also true both for the affective and the cognitive disturbances ('structure of consciousness'); the latter are not suitable for separating the psychopathological syndromes of epilepsies. A discrimination between 'genuine' and 'symptomatic' schizophrenia is no longer meaningful. (3) A true (hereditary) coincidence of (genuine) epilepsy and schizophrenia occurs obviously very seldom. (4) Numerous findings are presented, concerning the conditions in which schizophrenic-accentuated syndromes appear. The following relevant factors are discussed: hereditary, latency, duration of illness, type and frequency of seizures, type and localization of EEG foci, type, extent and topography of brain lesions, quantity and quality of psychopathological findings as well as 'organic' psychosyndromes. The possible triggering of psychoses by psychosocial factors, low intelligence, chronic folate deficiency and other specific risk factors and the role of neurotransmitter disorders (GABA hypotheses) are discussed. Finally proposals are made concerning prevention and therapy. Especially often diagnosed non-alternative schizophrenic syndromes in epileptic patients must be controlled by blood levels of antiepileptics. There is a transitional rank, constituted by defined determinants between the poles epilepsy and schizophrenia or a converging course of those syndromes. The results should lead to more frequent EEG and CT eventual magnetic resonance imaging or positron emission tomography-investigations in schizophrenic patients.

[Epilepsy and suicide]. / Epilepsie und Suizid.

Although statistics dealing with the causes of death are often difficult to compare, in some cases they indicate that suicide rates are high among people suffering from seizures. The author considers this critically. At present the number of attempted suicides among this group is at least five times higher than among the average population. The author reports on his own findings, on factors indicating potential suicide victims, and on the possible prevention of suicide, particularly in connection with pharmaceutical treatment.

[Psychotropic effects of antiepileptic drugs]. / Psychotrope Effekte der Antiepileptika.

Today the rank taken by antiepileptic drugs in the complex conditional fabric of mental disorders in epilepsies is well known. There are direct as well as indirect psychotropic effects caused by medication quite independent of other disorders which epilepsy based on or correlated with. It is of particular practical significance to control the concentration of drugs and their metabolic interactions by means of plasma levels which has nothing to do with a 'therapy of plasma levels'. The significance of plasma concentration, however, is becoming more and more evident. There exist today several antiepileptic drugs, meanwhile well researched and properly applied, which achieve, in terms of frequency and intensity, that progressively less mental disorders develop, establish or become chronic.

[Character changes in epilepsy?]. / Wesensänderung bei Epilepsien?

There are no personality structures which are typical of epilepsies in the sense of a change in character that can be seen in cross and especially in longitudinal sections. Reported changes of character due to epilepsies cannot be exactly defined reproducibly for the forms of fits to be differentiated and cannot, therefore, be used operationally. There is no doubt, however, that several causal factors must be considered to be responsible for the manifestation of certain frequently observed peculiarities and characteristics, respectively. In addition to organic, psychodynamic, and socio-situational causes, long-time antiepileptic medication is an essential factor of changes in character due to diseases characterized by fits. A better understanding has now been obtained of the importance of this particular factor, and this allows to conclude that there can only be epileptic functioning and reacting.

[Anticonvulsants and simultaneous medication - a problem in pregnancy (author's transl)]. / Antiepileptika und Begleitmedikation - ein Problem in der Schwangershaft.

As more recent investigations have shown, many women regularly take drugs not prescribed by the doctor during pregnancy, in addition to those that are. It is not always a matter of diseases which require treatment. It is shown, with reference to a number of patients, that unproblematic longterm anticonvulsant therapy - with years practically free from attack - can be complicated by pregnancy. During an essential treatment with multiple drugs made necessary by the pregnancy, 6 attacks of grand mal were recorded in 6 months and sometimes very low serum DPH concentrations were found in spite of reliable, high doses of Zentropil.