Clinical Neuroscience

[The use of concomitant Tetracor-Evipan in the electroencephalographic diagnosis of epileptic seizures]

SOMOGYI István1

NOVEMBER 01, 1959

Clinical Neuroscience - 1959;12(11)

[1. concurrent tetracor-evipan combined exercise in 93 predominantly unselected patients. Depth of sleep was deepened to Loomis f. stage C-D. 2. Combined loading was significantly more effective than simultaneous loading in the same patients. There were no cases in which the combined exercise was negative when either tetracor or evipan exercise was positive in the same patient, but there were 22 cases in which tetracor exercise was negative in patients in whom the combined exercise was positive. The same was true, although not as predominantly so because of fewer cases, for evipan loading. 3. No generalised seizures occurred during combined exercise. 4. The curve was not disturbed by artefacts or muscle potentials. The patient had the least "unpleasant" experience. 5. Based on the results, combined tetracor-evipan loading seems to be more effective than simultaneous loading and can be used as a routine method.]

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  1. Szegedi Ideg-és Elmekórtani Klinika

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Clinical Neuroscience

[Neurological complications of congenital vitium]

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[62 patients with congenital vitium were observed. Of these, 41 underwent regular neurological and 28 EEG examinations. Neurological complications were found in more than 50% (23) of the 41 cases, a higher percentage than the average reported in the literature. It is our hypothesis that to understand the pathomechanism of neurological lesions associated with congenital vitium, patients should be divided into two groups : 1) those in whom cerebral lesions are due to altered haemodynamic conditions and 2) those in whom hypoxaemia is the impairing factor. We analysed the clinical signs produced by hypoxaemia in our patient population and inferred the hypoxaemic tolerance of the brain. In our patients with non-cyanotic congenital vitium (4), we observed signs of reversible functional alteration of the nervous system on load, reversal of the shunt. However, this acute hypoxaemia led to irreversible damage in only one patient with vitium associated with sacer. In our neurologically negative cyanotic patients (6), we attributed the absence of symptoms to compensatory factors (vasodilatation, polyglobulia, etc.) for hypoxaemia. We found that polyglobulia does not parallel the degree of hypoxaemia. It is likely that these two compensating factors interact to varying degrees. Our neurologically negative cyanotic patients provide evidence that chronic hypoxaemia does not imply chronic hypoxydosis. We divided our cyanotic neurologically positive patients into 2 main groups, the complicated compensated adapted and the decompensated adapted. The former group includes 2 patients with cerebral abscesses. These are examples of damage caused by factors that confer adaptation. We have also found symptoms of cerebral anaemia as an acute manifestation of adaptations decompensated to exertion in our cyanotic patients. However, in these patients, unlike in non-cyanotic patients with vitium, we detected a certain percentage of irreversible lesions in the form of abnormal EEG even without loss of consciousness. We found two basic types of adverse effects of chronic hypoxaemia. Both are mainly reflected in EEG lesions. One is the consequence of serial loss of consciousness, the other is the cumulative effect of reversible impairment induced by acute hypoxaemia.]

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[Rare neurological lues: acute onset of Nissl-Alzheimer f. capillaris endarteritis meningoencephalitis]

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[The clinical presentation and pathological findings of luesian meningoencephalitis in Heveny and its sequelae were described. This case of luesian meningoencephalitis was based on an older and unclear origin of infection caused by Nissl-Alzheimer f. endarteriitis syphilitica. The luesian origin of the endarteritis in question and the primary nature of the vascular wall proliferation are confirmed by our findings and we emphasize that a similar encounter : acute luesian meningoencephalitis in the context of Nissl-Alzheimer f. endarteriitis is not described in previous reports.]

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[New data on the clinical and physiological relevance of nocturnal and diurnal epileptic seizures]

KAJTOR Ferenc, NAGY A. Tibor

[In a study of three hundred epileptic patients, the authors found a strong correlation between the occurrence of seizures during sleep (nocturnal) or during wakefulness (diurnal) and the anatomo-functional organisation of the epileptogenic focus. Sleep provides the most favourable association of preeconvulsive conditions for foci of the mediobasal stock of the temporal lobe, the anterior frontal and temporo-parieto-occipital convexity. Posterior frontal, central, parietal and external temporal cortical foci are primarily under the convulsive influence of wakefulness; focal motor or sensory motor seizures are awakened at night. The time of day at which the seizure occurs and the wakefulness it causes is itself a clinical manifestation of the focus, which also reflects some of the physiological functions of the focus, probably its role in inhibiting or facilitating wakefulness, attention and behavioural processes.]

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[Based on literature and our experience, we have described the treatment of barbiturate coma. The backbone of modern therapy is the central and peripheral ESt, the methodology and results of which were described and compared with the literature. Theories on the mechanism of action of ESt were outlined. We consider the most probable is the normalization of the reduction of barbiturate block-induced activation of the reticular activating system by extra nociceptive stimuli, and we consider ESt as such a nociceptive stimulus. ]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Clinical Neuroscience

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Clinical Neuroscience

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