bluuebunny/crossref_metadata_2025_split huggingface dataset:
Features of elderly patients admitted to a general hospital psychiatric unit
Authors: FURUKAWA Yoshiko , ODAWARA Toshinari , YAMADA Yasuhiro , FUJITA Jyunichi , HIRAYASU Yoshio 
Published: July 2006

AbstractBackground:  Improved management of elderly psychiatric patients requires further identification of their special needs and problems.Methods:  We analyzed the characteristics of 1333 consecutive patients admitted to the Psychiatric Center of Yokohama City University Medical Center, a general hospital psychiatric unit, from January 2000 to December 2003. Patients 65 years old or older (the elderly group) accounted for 12.3% of all patients.Results:  The duration of admission in elderly patients was significantly longer than in younger patients (less than 65 years old). Admission history and admission type were significantly different between these two groups. Prevalence of dementia or delirium as a primary or secondary diagnosis was significantly greater in the elderly group. About three‐quarters of elderly patients were diagnosed as having a mood disorder (47.6%), or an organic mental disorder (31.1%). A significantly smaller fraction of patients were placed in seclusion in the elderly group than in the younger group, although the fraction of patients who were restrained did not differ between the two groups. A significantly higher fraction of elderly patients was transferred to general medical or surgical wards in the hospital to continue treatment for physical illness. In the elderly group, physical and mental prognoses were poorest in patients with organic mental disorders.Conclusions:  Compared with the younger patients, the elderly psychiatric patients showed peculiar features. They were thought to require the treatments that were adapted to meet their needs.
Influence of the FDA Talk Paper upon the use of atypical antipsychotics for psychotic symptoms in older patients with dementia in Japan
Authors: FUKUDA Koji , TANAKA Makoto 
Published: July 2006

AbstractBackground:  Atypical antipsychotic medications have often been used in the treatment of behavioral and psychological symptoms of dementia (BPSD). Recently, the US Food and Drug Administration (FDA) issued new safety information concerning atypical antipsychotic drugs, indicating that their use may increase the risk of cardiovascular adverse events among elderly adults with BPSD. Based on this information, the Japanese Ministry of Health, Labor and Welfare issued a similar warning against the use of atypical antipsychotic drugs licensed in Japan. We then sought to determine whether or not the use of typical antipsychotics should be recommended to replace atypical antipsychotics. In this paper, we discuss the influence of these warnings on the withholding of use of risperidone exemplified in seven case histories.Methods:  Seven inpatients who exhibited BPSD received risperidone monotherapy in our hospital. In response to the FDA notice, the atypical antipsychotics used to treat these patients were replaced with typical antipsychotic agents.Results:  During the period of risperidone administration, all patients exhibited clinical improvement compared with their baseline results and showed no adverse events. Two of our seven patients developed psychotic exacerbation and exhibited extrapyramidal symptoms coinciding with the replacement of risperidone with conventional antipsychotics.Conclusion:  To the best of our knowledge, this is the first clinical report on the influence of the FDA alert on the use of atypical antipsychotics for psychotic symptoms in older patients with dementia in Japan. In two of our seven BPSD cases, there was no benefit from taking conventional antipsychotics. Our results lead to the conclusion that the use of typical antipsychotics should not be recommended to replace atypical antipsychotics. Although close attention should be paid to the FDA alert, clinicians must take into consideration the balance of benefits and risks when evaluating the appropriate use of antipsychotics in older patients with dementia.
Cerebrospinal Fluid Biomarkers in Primary Headache Disorders
Authors: Harrington Michael G. 
Published: July 2006

Objective.—The object of this review is to examine the published literature for cerebrospinal fluid laboratory measures of primary headache disorders to identify biomarkers and provide recommendations for future biomarker discovery.Background.—Biomarkers may distinguish deviation from a normal state, provide insight into mechanisms of pathophysiology, quantify the degree of change, discriminate what may be clinically overlapping disorders, and allow monitoring and/or selection of specific treatment. High‐throughput, discovery technologies fuel the ability to reveal more biomarkers than past hypothesis‐driven studies.Design or Methods.—Publications were identified in PubMed, ISI web of knowledge (both Web of Science and BIOSYS), and SciFinder, using the key words for cerebrospinal fluid (CSF) and migraine, headache, or biomarkers. Additional references were sought from the papers identified in these searches. Data were assessed relating to all primary headache types for clinical and scientific methods and results.Results.—Fifty‐five out of 82 biomarkers were found from 55 publications, though none have been validated for clinical utility. Data for site (ventricular, cervical, lumbar) and timing of CSF collection, headache state, and diagnostic description were patchy, and controls were often poorly defined. Most routinely performed CSF measurements were within normal limits. Most levels of pain‐related molecules were reduced, and concentrations of most neurotransmitters, neuropeptides, proteins, and small molecules were increased. Though few studies assessed the specificity of biomarkers for primary headaches, it is clear that there are differences in CSF biomarkers between migraine, cluster headache, tension‐type headache, and trigeminal neuralgia.Conclusions.—The high proportion (67%) of biomarkers identified from laboratory measures tested thus far predicts that many more biomarkers will be identified for primary headaches when more candidates are evaluated. In order to discover and evaluate more biomarkers, especially those that may have clinical application for headache management, 3 recommendations are encouraged: prospective design of care‐independent studies; evaluation of more clinical variables; and evaluation of substantially more candidates by using discovery‐based research methods. Outlines of approaches to pursue these aims are proposed.
Migrainous Vertigo: Mutation Analysis of the Candidate Genes CACNA1A, ATP1A2, SCN1A, and CACNB4
Authors: Von Brevern Michael , Ta Nga , Shankar Anupama , Wiste Anna , Siegel Anne , Radtke Andrea , Sander Thomas , Escayg Andrew 
Published: July 2006

Background.—Migrainous vertigo (MV) is increasingly recognized as a common cause of episodic vertigo. MV displays several clinical similarities with familial hemiplegic migraine (FHM) and episodic ataxia type 2 (EA‐2), which have been linked to mutations in 3 genes, CACNA1A, encoding a neuronal calcium channel α subunit, ATP1A2, encoding a catalytic subunit of a Na+/K+‐ATPase, and most recently the voltage‐gated sodium channel SCN1A. The present study explored the hypothesis that mutations in CACNA1A, ATP1A2, SCN1A, and the calcium channel β4 subunit CACNB4 confer susceptibility to MV.Methods.—Mutation analysis of the coding exons and exon/intron junctions of CACNA1A, ATP1A2, SCN1A, and CACNB4 was performed in 14 unrelated MV patients by conformation sensitive gel electrophoresis and automated sequence analysis.Results.—Analysis of the 4 candidate genes in the 14 MV patients resulted in the identification of a total of 26 sequence variants. The silent substitution D29D in CACNB4 was observed in 2 MV patients and was not present in 46 ethnically matched control DNA samples. The remaining variants were also observed in control DNA samples and the allele frequencies of variants that resulted in amino acid substitutions were not significantly different between patients and controls.Conclusions.—Based on this group of patients there is no evidence that the genes causing FHM and EA‐2 represent major susceptibility loci for MV.
From Transformed Migraine to Episodic Migraine: Reversion Factors
Authors: Seok Jung Im , Cho Hyung In , Chung Chin‐Sang 
Published: July 2006

Objective.—To identify the factors contributing to the reversion of transformed migraine (TM) into episodic migraine.Background.—TM, the most common and important subtype of chronic daily headache (CDH), has a great effect on a patient's quality of life. However, its clinical course and outcome predictors have rarely been studied prospectively.Method.—Of 1142 consecutive headache patients seen at the Headache Clinic of the Samsung Medical Center, the patients with TM (frequency >15/month for >6 months and a history of migraine meeting the ICHD‐II diagnostic criteria) were followed for at least 1 year. We analyzed the demographic data, clinical course, and compliance factors, such as those of the physician's management protocol and recommended lifestyle modification.Results.—A total of 136 patients finished the final follow‐up assessment 1 year after the initial evaluation. Ninety‐five patients (70%) converted from TM to episodic migraine. Forty‐one patients (30%) continued to suffer daily headaches without a period of improvement. The demographic and clinical information collected before the treatment was not significantly related to outcome, except for chronic use of analgesics for other medical conditions (P= .01). Of the compliance factors, good compliance with preventive medication (P < .001), withdrawal from continuous use of analgesics for headache relief (P < .001), and regular exercise (P= .04) were significant positive contributors to the reversion of TM into episodic migraine.Conclusion.—Compliance factors are the most important factors that determine the reversion of TM into episodic migraine.
Cerebral Vasoreactivity is Influenced by the Prandial State Among Migraineurs
Authors: Coelho Rodolfo de S. , Gomes Ciro M. , Teixeira Ricardo A. 
Published: July 2006

Objective.—To test if the cerebral vasoreactivity among migraineurs is influenced by the prandial state.Design and Methods.—Eight patients with migraine without aura were studied (mean age = 23.75 years; range = 19 to 32 years; 6 women). We also studied 8 healthy controls (mean age = 20.63 years; range = 18 to 22 years; 3 women), with no history of migraine. Cerebral vasoreactivity was measured on the right side by the breath holding index (BHI) using an EZ‐Dop transcranial Doppler instrument, with a 2‐MHz transducer fitted on a headband. Serum glucose levels were measured after a 10‐hour fasting period and then 10 minutes after a standardized breakfast.Results.—In both groups, we found a postprandial (PP) glycemia enhancement (P < .02). Migraineurs showed enhanced PP cerebral vasoreactivity when compared to the fasting state (FS) (BHI‐PP = 1.46; BHI‐FS = 1.16; P= .02). Among controls, we found a trade to enhancement, but without statistic significance (BHI‐PP = 1.28; BHI‐FS = 1.11; P= .30). Glucose levels were not significantly correlated to cerebral vasoreactivity in any of the groups (P > .05).Conclusion.—Our findings suggest that migraineurs have a higher reactivity to hypercapnia during the PP period.
Decreased Dopamine D2/D3‐Receptor Binding in Temporal Lobe Epilepsy: An [18F]Fallypride PET Study
Authors: Werhahn Konrad J. , Landvogt Christian , Klimpe Sven , Buchholz Hans‐Georg , Yakushev Igor , Siessmeier Thomas , Müller‐Forell Wibke , Piel Markus , Rösch Frank , Glaser Martin , Schreckenberger Mathias , Bartenstein Peter 
Published: July 2006

Summary:  Purpose: Although animal data are suggestive, evidence for an alteration of the extrastriatal dopaminergic system in human focal epilepsy is missing. Methods: To quantify D2/D3‐receptor density, we studied seven patients with temporal lobe epilepsy (TLE) and nine age‐matched controls with positron emission tomography (PET) by using the high‐affinity dopamine D2/D3‐receptor ligand [18F]Fallypride ([18F]FP) suitable for imaging extrastriatal binding. TLE was defined by interictal and ictal video‐EEG, magnetic resonance imaging (MRI), and [18F]fluorodeoxyglucose ([18F]FDG)‐PET and was due to hippocampal sclerosis (HS), based on histology in all patients. Primary analysis was based on regions of interest (ROIs) defined on individual MRIs. For each patient, binding potential (BP) was calculated by using the simplified reference tissue model, and the epileptogenic was compared with the unaffected hemisphere in each ROI. To confirm the results, an additional voxel‐based group analysis was performed by using statistical parametric mapping. Results: Compared with controls, [18F]FP BP was significantly decreased in the epileptogenic temporal lobe in all patients. On ROI analysis, this reduction was evident in areas surrounding the seizure‐onset zone at the pole (–34.2%) and lateral aspects (–32.9%) of the temporal lobe. Although the hippocampus [18F]FDG uptake (–8.1%) and hippocampal MR volume (–35.1%) were significantly reduced, no significant decrease of [18F]FP BP was found. Reduction of [18F]FP BP did not correlate with hippocampal atrophy. Conclusions: D2/D3‐receptor binding is reduced at the pole and in lateral aspects of the epileptogenic temporal lobe in patients with mesial TLE and HS. This area might correspond to “the irritative zone,” indicating that D2/D3 receptors might play a specific role in the pathophysiology of mesial TLE.
Speech Recognition Impairments in Patients with Intractable Right Temporal Lobe Epilepsy
Authors: Boatman Dana F. , Lesser Ronald P. , Crone Nathan E. , Krauss Gregory , Lenz Frederick A. , Miglioretti Diana L. 
Published: July 2006

Summary:  Purpose: To evaluate speech recognition in patients with focal intractable epilepsy and surgical resections in the nondominant (right) hemisphere. Methods: Speech recognition was tested prospectively, under different listening conditions, in 22 patients with right temporal lobe (11 patients) or extra–temporal lobe epilepsy. All were left‐hemisphere dominant for language on preoperative intracarotid sodium amobarbital testing. Results: All patients demonstrated normal auditory recognition of words and environmental sounds before and after surgery. However, when real‐world listening conditions were simulated by using acoustically degraded (filtered) words, patients with temporal lobe epilepsy performed significantly worse than patients with frontal or parietooccipital lobe epilepsy before and after surgery (p < 0.0001). Conclusions: Patients with intractable right temporal lobe epilepsy are at risk for speech recognition impairments in real‐world listening environments, independent of surgery. The impact of speech recognition difficulties on verbal communication, coupled with the prevalence of adverse listening environments, underscores the importance of testing speech recognition under different listening conditions in patients with intractable right temporal lobe epilepsy.
Extratemporal White Matter Abnormalities in Mesial Temporal Lobe Epilepsy Demonstrated with Diffusion Tensor Imaging
Authors: Gross Donald W. , Concha Luis , Beaulieu Christian 
Published: July 2006

Summary:  Purpose: Recent studies have demonstrated bilateral white matter abnormalities in temporal lobe epilepsy (TLE) patients with unilateral mesial temporal sclerosis (MTS). The purpose of this project was to determine whether abnormalities of water diffusion are seen in extratemporal white matter of patients with TLE and pathologically confirmed MTS and to determine whether these findings are associated with worse surgical outcome. Methods: Eleven patients with TLE and unilateral MTS confirmed in surgical specimens and 14 controls were studied by using cerebrospinal fluid–suppressed diffusion tensor imaging (DTI) and T2 relaxometry. Results: Hippocampal T2 signal for patients was significantly elevated both ipsilateral (p < 0.001) and contralateral (p = 0.006) to MTS. DTI demonstrated reduced fractional anisotropy of the genu of the corpus callosum (p = 0.003) and external capsule (p = 0.02) and elevated mean diffusivity of the genu (p = 0.005), splenium (p = 0.03), and external capsule (p < 0.001). For both the genu and external capsule, parallel diffusion of patients was not different from that of controls (genu, p = 0.81; external capsule, p = 0.45), whereas perpendicular diffusion was elevated (genu, p = 0.001; external capsule, p < 0.001). With mean postsurgical follow‐up of 18.5 months, eight of 11 patients were entirely seizure free and the remaining three had all experienced a worthwhile reduction in seizure frequency. Conclusions: Our findings suggest that although patients with TLE and MTS have extensive bilateral and extratemporal pathology, these findings may not be associated with a worse postsurgical outcome.
Hippocampal Kindling Leads to Motor Map Expansion
Authors: Van Rooyen Francine , Young Nicole A. , Larson Sarah E. M. , Teskey G. Campbell 
Published: July 2006

Summary:  Purpose: To determine whether seizure activity, repeatedly elicited in the hippocampus, could alter the functional organization of neocortical movement representations (motor maps) and whether a relation exists between the number of afterdischarges recorded in the sensorimotor neocortex and the size of the motor maps. Methods: We electrically kindled the right ventral hippocampus of Long–Evans hooded rats, twice daily, for 40 sessions and recorded the afterdischarges in the stimulated hippocampus and right sensorimotor neocortex. Between 3 and 7 days after the last seizure, we used high‐resolution intracortical microstimulation to derive the forelimb‐movement representations in the left (un‐implanted) sensorimotor neocortex. Results: In the hippocampal kindled rats, we observed a dramatic expansion of the area of neocortex that would elicit forelimb movements compared with sham‐kindled controls. The number of afterdischarges recorded in the neocortex was significantly and positively correlated with the size of the motor maps. Conclusions: Seizures propagating from the hippocampus have long‐distance effects on the functional organization of motor maps.
Volumetric Evidence of Bilateral Damage in Unilateral Mesial Temporal Lobe Epilepsy
Authors: Araújo David , Santos Antônio C. , Velasco Tonicarlo R. , Wichert‐Ana Lauro , Terra‐Bustamante Vera C. , Alexandre Veriano , Carlotti Carlos G. , Assirati João A. , Machado Hélio Rubens , Walz Roger , Leite João P. , Sakamoto Américo C. 
Published: July 2006

Summary: Purpose:We sought to analyze the contralateral volumes of the temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus in patients with temporal lobe epilepsy (TLE) due to histologically proven mesial temporal lobe sclerosis (MTLS), seizure free for ≥4 years of postsurgical follow‐up.Methods:Forty‐six (23 male) TLE patients, operated on between 1996 and 2001, with histopathologic diagnosis of MTLS, and a postsurgical follow‐up of ≥4 years, had their temporal lobe structures manually segmented, measured, and compared with those of 23 normal volunteers, paired as groups for sex, age, and handedness.Results:The mean volumes of the contralateral temporal pole, hippocampus, and parahippocampal gyrus in TLE patients were significantly lower than those in controls.Conclusions:MRI volumetric data show that the damage in TLE due to MTS may be more widespread and bilateral, even in patients with unilateral TLE by clinical and neurophysiological criteria. Our results are relevant to the discussion of epileptogenic mechanisms in TLE.
Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort
Authors: Grivas Athanasios , Schramm Johannes , Kral Thomas , Von Lehe Marec , Helmstaedter Christoph , Elger Christian E. , Clusmann Hans 
Published: July 2006

Summary: Purpose:Surgical treatment of refractory temporal lobe epilepsy (TLE) is promising for selected patients, but only little experience has been acquired in operating on older patients, especially with limited resections. We intend to delineate clinical and surgical factors influencing outcome in patients older than 50 years at operation and to compare the results with those of a younger patient cohort.Methods:Fifty‐two patients older than 50 years were operated on for intractable mesial or combined mesiolateral TLE between 1991 and 2002. The mean age at operation was 55 years, and the mean duration of epilepsy was 33 years. Forty selective amygdalohippocampectomies (33 for hippocampal sclerosis, seven for removal of a mesiotemporal lesion), five lateral temporal lesionectomies plus amygdalohippocampectomy, and seven anterior temporal lobectomies were performed. Eleven (21%) patients had undergone invasive presurgical video‐EEG monitoring. The mean follow‐up period was 33 months. We compared the results with those of a younger cohort operated on in the same time period.Results:Thirty‐seven older patients attained complete seizure control (71% class I), and 10 patients had only rare postoperative seizures (19% class II). Four patients improved >75% (8% class III), and one patient did not improve (2% class IV). The same rate of seizure control was attained by 11 patients older than 60 years at surgery. These results were not significantly different from those in a younger patient group. A trend toward better seizure control was noted in 16 patients with an epilepsy duration of <30 years (all class I or II), and in 20 patients with a seizure frequency of fewer than five seizures per month (all class I or II). No mortality resulted from a total of 65 diagnostic and therapeutic procedures. A 3.8% permanent neurologic morbidity (dysphasia and hemiparesis) was noted. Hemianopia occurred in three (5.9%) patients. Neuropsychological testing revealed low preoperative performances and some gradual further deterioration after surgery.Conclusions:Results of surgery for TLE with mainly limited resections are promising in patients older than 50 years and older 60 years, despite the long seizure history. As expected, the risk of complications is somewhat higher compared with that in a younger control group. The impact of low neuropsychological performance is a concern.
Musicogenic Seizures Can Arise from Multiple Temporal Lobe Foci: Intracranial EEG Analyses of Three Patients
Authors: Tayah Tania F. , Abou‐Khalil Bassel , Gilliam Frank G. , Knowlton Robert C. , Wushensky Curtis A. , Gallagher Martin J. 
Published: July 2006

Summary: Purpose:To determine the ictal‐onset zone of musicogenic seizures by using intracranial EEG monitoring.Methods:Musicogenic seizures in three patients with medically intractable musicogenic epilepsy were first localized by using noninvasive methods including, in one patient, ictal magnetoencephalography (MEG) and magnetic resonance spectroscopy (MRS). The ictal‐onset zones in these patients were then further localized using by intracranial EEG monitoring, and the outcomes of the two patients who underwent epilepsy surgery were determined.Results:Patient 1's musicogenic seizures localized to the right lateral temporal lobe, patient 2's originated in the right mesial temporal lobe, and patient 3's arose independently from both mesial temporal lobes. Patients 1 and 2 underwent resective epilepsy surgery and are seizure free (Engel class I).Conclusions:Musicogenic epilepsy is a heterogeneous syndrome with seizures that can arise from multiple temporal lobe foci. Patients with medically intractable musicogenic epilepsy and with unilateral ictal onset zones may be considered candidates for resective epilepsy surgery.