[Evolution of the conditions for EEG recording in the diagnosis of brain death]. / Evolution des conditions d'enregistrement de l'EEG pour le diagnostic de la mort cérébrale.

The authors trace the evolution of conditions of EEG recording parallel to the clinical criteria of certainty of the diagnosis of brain death, since the first definition of irreversible coma given by M. Goulon and P. Mollaret in 1959. They notice that over the past 30 years, the duration of the EEG has been reduced, their frequency decreased, and the delay between the clinical diagnosis of brain death with flat EEG and the switching off of the cardio-respiratory ventilation have been reduced from 48 to 6 h, thus enabling extremely early removal of organs; the slow progress of this evolution is explained by the difficulty over the years in distinguishing between brain death and certain reversible pathological conditions which resemble it, and by the fact that some EEGs may take some time to become flat. Actually, once these special cases have been eliminated, after the clinical diagnosis of brain death has been ascertained, we observe that two flat EEGs at an interval of 6 h are never subsequently modified. Finally, the EEG, a non-invasive method, seems always to be the quickest and the easiest method to carry out and especially to repeat, without any particular problem of staff or of place and is, thus, a reliable testimony in the event of medico-legal controversy.

[Treatment of status epilepticus in the adult. Retrospective analysis of 192 cases treated in intensive care units]. / Traitement de l'etat de mal épileptique de l'adulte. Analyse rétrospect 192 cas traités en réanimation.

The results of therapy have been analyzed in a series of 192 patients admitted for status epilepticus over 7 years in two intensive care units. Most (142 cases without any prior epilepsy) corresponded to secondary forms. In 2/3 of the cases, the patients were admitted because of failure of benzodiazepines and/or phenobarbitone. Sodium thiopentone achieved control of seizures in 75%; short-acting barbiturates should be especially prescribed in grand mal status with impending brain anoxia. Diphenylhydantoin would appear suitable in non-life-threatening conditions such as serial seizures or partial status. Chlormethiazole often succeeds in controlling convulsive status which has proved refractory to other treatment. Supportive management is mandatory: 52% of patients required respiratory assistance. Fatalities (36%) exclusively correspond to the underlying cerebral conditions and systemic disorders.

[Status epilepticus in the adult. Epidemiologic and clinical study in an intensive care unit]. / Etat de mal épileptique de l'adulte. Etude épidémiologique et clinique en réanimation.

The present study, conducted between January 1975 and June 1983, includes 282 adult patients admitted for status epilepticus (SE) in 2 intensive care units (3.5% of all admissions). In their great majority, i.e., 201, patients had no previous history of epilepsy, and initiated the SE during the course of recent affections such as brain or systemic diseases. In 81 patients with previous seizure, epilepsy was idiopathic in 20, and symptomatic in 61, the 3 main causes being cranial traumatism, cerebrovascular accident and chronic alcoholism. SE was of various causes. The most frequent were cerebro-vascular disease, post-anoxic encephalopathy, intoxication, bacterial or viral meningo-encephalitis. In some patients, SE was preceded by manifestations such as convulsions, behavorial disturbances or conscience impairment. One should be aware of these facts and undertake or increase an anticonvulsivant medication at their onset. Duration of SE, when clearly established, was highly variable but had no apparent correlation to sequelae or death occurrences. SE itself was directly related to death in only 2 cases; in all other instances death was the consequence of the primary disease. These results are consistent with previous reports: presently SE occurs more frequently in the course of other affections than in prior epileptic patients. The better vital prognosis of SE is due to the simultaneous conjunction of new anticonvulsivant medication and supportive care associated with the cure of the causative disease.

[Myoclonus of toxic origin]. / Myoclonies d'origine toxique.

EEG, EMG and clinical correlates of myoclonus due to poisoning are reviewed. The authors propose a classification into two groups. I. Sporadic diffuse asynchronous asymmetrical myoclonic jerks, responding to treatment. These states are encountered essentially in acute intoxication by vegetal poisons (strychnine), rodenticide (chloralose) and various medications (isoniazide, tricyclic antidepressant agent, lithium). These transitory manifestations are functional and prognosis is favourable. II. Subintrant generalized synchronous symmetrical myoclonus, uncontrolled by therapeutics. These myoclonus states observed over weeks or months are frequently consecutive to organic injuries due to direct toxicity (methylbromide) or after anoxia (toxic cardiac arrest). EEG and EMG correlations are very inconstant in both groups. EEG abnormalities are a sign of cortical and/or subcortical dysfunction. Normal EEG suggests a disease of the lower central nervous structure (brain stem, medulla). Chronic bismuth and dialysis encephalopathies are also related. Withdrawal syndrome with myoclonus jerks after sudden cessation of barbiturate or benzodiazepine long-term treatment is mentioned.

[Methyl bromide poisoning. 3 cases, 1 fatal. Neruopathological study of one case of coma with myoclonus followed for 5 years]. / Intoxication par le bromure de méthyle Trois observations, dont une mortelle Etude neuro-pathologique d'un cas de stupeur avec myoclonies, suivi pendant cinq ans

Three new cases of methyl bromide poisoning (leakage from a fire extinguisher) are reported. Two of these were characterized, after an initial period of coma and myoclonic status, by an action myoclonus. Electrical data are presented. A follow up of 4 and 8 years allowed to study the effect of drugs, two of which (clonazepam and baclofene) being pecularly contributive. The third patient outlived for 5 years in a stuporous state with myoclonus. The anatomical findings consisted mainly of a necrosis of both inferior colliculi with gliosis in the upper brain stem reticular formation and moderate changes in the dentate and pontine nuclei. Their significance is discussed in view of physiological and experimental knowledge.