An Analysis of Nucleotide-Amyloid Interactions Reveals Selective Binding to Codon-Sized RNA

Interactions between RNA and proteins are the cornerstone of many important biological processes from transcription and translation to gene regulation, yet little is known about the ancient origin of said interactions. We hypothesized that peptide amyloids played a role in the origin of life and that their repetitive structure lends itself to building interfaces with other polymers through avidity. Here, we report that short RNA with a minimum length of three nucleotides binds in a sequence-dependent manner to peptide amyloids. The 3'-5' linked RNA backbone appears to be well-suited to support these interactions, with the phosphodiester backbone and nucleobases both contributing to the affinity. Sequence-specific RNA-peptide interactions of the kind identified here may provide a path to understanding one of the great mysteries rooted in the origin of life: the origin of the genetic code.

Branch site bulge conformations in domain 6 determine functional sugar puckers in group II intron splicing

Although group II intron ribozymes are intensively studied the question how structural dynamics affects splicing catalysis has remained elusive. We report for the first time that the group II intron domain 6 exists in a secondary structure equilibrium between a single- and a two-nucleotide bulge conformation, which is directly linked to a switch between sugar puckers of the branch site adenosine. Our study determined a functional sugar pucker equilibrium between the transesterification active C2'-endo conformation of the branch site adenosine in the 1nt bulge and an inactive C3'-endo state in the 2nt bulge fold, allowing the group II intron to switch its activity from the branching to the exon ligation step. Our detailed NMR spectroscopic investigation identified magnesium (II) ions and the branching reaction as regulators of the equilibrium populations. The tuneable secondary structure/sugar pucker equilibrium supports a conformational selection mechanism to up- and downregulate catalytically active and inactive states of the branch site adenosine to orchestrate the multi-step splicing process. The conformational dynamics of group II intron domain 6 is also proposed to be a key aspect for the directionality selection in reversible splicing.

One-year prevalence of migraine in Austria: a nation-wide survey

This study presents the first nation-wide survey of migraine in Austria. A sample of 997 Austrian > or = 15 years old were interviewed personally (face-to-face) in a random sample in the whole country. Diagnosis of migraine was based on the International Headache Society (IHS) classification. Of the Austrian adult population 10.2% were identified to suffer from IHS migraine, 5.6% from migraine without aura, 2.3% from migraine with aura and 2.3% from borderline migraine. Another 8.5% have possible migraine. Other primary headaches were reported in 30.7%. Sex, age, working status and region were found to be the main demographic influencing factors. Further influences were stress, spinal column problems or weather changes. The most used acute medications were over-the-counter drugs, doctor attendance rate was very low. Working people with migraine dropped out of work 14 days per year, which adds up to 6.8 million working days per year. This remains a substantial economic factor. The findings indicate that migraine sufferers in Austria need to be more informed about their illness and what to do against it, especially encouraging doctor visits.

[Incidence and cost estimation of diseases of the nervous system and the psyche. An evaluation of non-profit hospitals]

There were 273,722 hospitalizations due to neurological disorders reported in Austria's nonprofit hospitals in 1997, including the related operated cases (14.12% of all 1.9 million hospitalizations). The individual disease groups, e.g., cerebrovascular disorders (59,269 admissions or 3.06%), multiple sclerosis (3,920 admissions or 0.2%) are detailed and the cost resulting from these diseases were estimated according to the Austrian Diagnosis Related Groups. The number of hospitalizations due to psychiatric disorders was 99,346 (5.13%). According to our results, we were able to estimate that 6,492 beds (at the moment 2,053 beds) were required for inpatient treatment in the area of neurology and psychiatry, which means one bed per 1,260 inhabitants.

Hospitalization of patients with neurological disorders and estimation of the need of beds and of the related costs in Austria's non-profit hospitals

In 1997, 273 722 hospitalizations as a result of neurological disorders, including the related operated cases, were reported in Austria's non-profit hospitals (80% of all hospitals). They represent 14.12% of all 1.9 million in-patient treatments. The individual disease groups, e.g. cerebrovascular disorders (59 269 admissions or 3.06%), multiple sclerosis (3920 admissions or 0.2%) and all other groups are detailed. We estimated the cost resulting from these diseases which amounted to 11.88% of all hospital costs. We were also able to estimate that 5549 beds are required for in-patient treatment in the area of neurology, assuming an average duration of treatment of 8 days (Austrian mean value for neurological disorders). This is equivalent to one bed per 1367 inhabitants or 11.31% of all beds for in-patient treatment in non-profit hospitals in Austria. Obviously at present the majority of neurological patients are treated in non-neurological departments. A major increase in resources to neurology is necessary if patients are to receive the benefit of specialized diagnosis and treatment. These further resources not only cover the increase of neurological beds in hospitals but also financial, personal resources and in consequence increased capacity for neurological education, training and research.

A 28-week, double-blind, placebo-controlled study with Cerebrolysin in patients with mild to moderate Alzheimer's disease

Cerebrolysin (Cere) is a compound with neurotrophic activity which has been shown to be effective in the treatment of Alzheimer's disease (AD) in earlier trials. The efficacy and safety of repeated treatments with Cere were investigated in this randomized, double-blind, placebo-controlled, parallel-group study. One hundred and forty-nine patients were enrolled (76 Cere; 73 placebo). Patients received i.v. infusions of 30 ml Cere or placebo 5 days per week for 4 weeks. This treatment was repeated after a 2-month therapy-free interval. Effects on cognition and clinical global impressions were evaluated 4, 12, 16, and 28 weeks after the beginning of the infusions using the Clinical Global Impression (CGI) and the Alzheimer's Disease Assessment Scale-cognitive subpart (ADAS-cog). All assessments, including the 28-week follow-up visit were performed under double-blind conditions. At week 16, the responder rate of the Cere group was 63.5% on the CGI, compared to 41.4% in the placebo group (P < 0.004). In the ADAS-cog, an efficacy difference of 3.2 points in favour of Cere was observed (P < 0.0001). Notably, improvements were largely maintained in the Cere group until week 28, 3 months after the end of treatment. Adverse events were recorded in 43% of Cere and 38% of placebo patients. Cere treatment was well tolerated and led to significant improvement in cognition and global clinical impression. A sustained benefit was still evident 3 months after drug withdrawal.

Migraine-like headache in bacterial meningitis

The effect of sumatriptan has not been previously described in the treatment of the headache of meningitis, although this headache has similarities to migraine. This study presents the clinical features of two patients who had fulminant bacterial meningitis with migraine-like headache and who experienced no improvement in headache intensity after administration of sumatriptan 6 mg s.c. On these grounds the lack of response of this type of headache to sumatriptan is discussed.

Transcutaneous electrical nerve stimulation in the treatment of chronic pain: predictive factors and evaluation of the method

OBJECTIVE

Transcutaneous electrical nerve stimulation (TENS) is a widely used therapeutic approach in acute and chronic pain syndromes. The aim of this study was to investigate the influence of patient management as well as other factors on the outcome of TENS treatment.

DESIGN

The study was carried out as a retrospective analysis of the course of treatment and the therapeutic results of transcutaneous electric nerve stimulation (TENS) in 482 patients with chronic pain of various origins. The follow-up period was up to 48 months. Two groups with differing patient management were compared.

RESULTS

Competent patient evaluation and education (i.e., a long testing and learning phase as well as regular comprehensive after-care) was found to be important. Our analysis of the reasons for the discontinuation of long-term TENS therapy showed that the most important feature was the discrepancy between effort and therapeutic result. Other causes were intermittent depressive states and progression of the underlying disease followed by an aggravation of pain. In addition, numerous factors were identified that adversely affected the outcome of TENS treatment. These factors were listed in order of importance and were included in a prognostic score.

CONCLUSIONS

The prognostic score permits an efficient selection of patients. Moreover, a comprehensive documentation of pain syndromes and their organic, psychogenic, and social features is presented. On the basis of this documentation, an appropriate therapeutic concept may be established. The prognostic score was validated in a subsequent study including 99 patients with chronic pain treated with TENS.

Clinical case report: opiate antagonist and event-related desynchronization in 2 autistic boys

Event-related desynchronization and visual orientational behavior were examined in 2 autistic boys to determine if blockade of endogenous opioid activity facilitates cognitive processing at a cortical level. Before naltrexone, the boys showed no selective alpha blocking during exposure to either mother's pictures or white light. Unlike normals, they exhibited strong alpha band enhancement at temporocentral recording sites. Two hours after administering 0.5 mg/kg naltrexone, mother-as well as light-related alpha blocking appeared at occipital, occipitotemporal, and prefrontal sites. These effects were gone 24 h after dosing in one child, but persisted in the other. A parallel increase in visual pursuit in a social context was observed. These results affirm that autistic gaze aversion can be caused by excessive opioid activity interfering with corticothalamocortical processing of visual stimuli.

[Long-term outcome of monoradicular lumbosacral compression syndromes-a comparison of pain and neurological deficits with lumbar CT scan.]

A total of 97 patients with an acute monoradicular lumbosacral compression syndrome and a herniated disc at the same level were reinvestigated an average of 25 months after the acute event. Assessment was based on CT investigation and "root score", which was compiled from reports of subjective complaints and neurological deficits. All patients had initially undergone conservative treatment as inpatients. At the time of reinvestigation CT examination of the herniated discs revealed that they were unchanged in 56.7%, some-what smaller in 34%, no longer visible in 4.1% and larger in 5.2%. Nevertheless, 53.6% of patients were free of complaints, while 23.7% had improved clinically by more then 75%. The remainder showed improvement by about 25-75%. In no patient was the score unchanged or worse. In 69% of the patients neurological deficits were no longer demonstrable, and the remaining patients were not aware of deficits or did not feel any impairment from deficits that were obvious on clinical example. In 22.7% impairment was caused solely by local radicular or pseudoradicular pain. From these results it can be concluded that herniation of the disc precipitates the acute event but is not the sole source of the pain. In the majority of cases, during the further course of the disease the herniated disc causes no pain. It appears, therefore, that the course of disease following a disc herniation can be influenced very favourably by non-operative treatment and that in more than 50% of cases the condition becomes clinically silent. It follows that in neuroradicular compression syndromes a neurological deficit associated with the acute event does not mean operative intervention is indicated.

[Social problems and rehabilitation of the Parkinson patient]

The rehabilitation of parkinson patients is being discussed with the legal situation in mind. Summing up we can say: Drug therapy as the most important part of medical rehabilitation has achieved a high standard. Further information and education may help in keeping and advancing the standard. It could be a task not only for the Austrian Parkinson Society and self-help groups yet to be founded, and one well worth supporting, to establish programs and recommendations for adequate physio- and physico-therapy, in general and especially with regard to sanatoriums. This should also include in patient rehabilitation in special institutions or special departments within existing rehabilitation centers and clinics as well as promoting follow-up treatment. Patient clubs and self-help groups could considerably contribute to vocational and social rehabilitation.

A comparison of laser acupuncture versus placebo in radicular and pseudoradicular pain syndromes as recorded by subjective responses of patients

In a prospective randomized single blind cross over study the analgesic effects of laser irradiation on acupuncture points and a mock laser treatment (placebo) were compared in a sample of 21 patients suffering from radicular and pseudoradicular pain syndromes. Subjective pain levels were recorded on a visual verbal analogue pain rating scale before and after laser treatment and placebo along with the duration of any effects on pain observed. Mean pain levels after laser treatment were statistically significantly lower than after placebo (p less than 0.001, t-test). In the cross over section laser treatment was more effective than placebo in 20 out of 21 patients and pain relief lasted longer after laser treatment in 18 out of 21 patients.

[Phenomenology of Huntington chorea, analysis of a large family]

The marked variability of psychiatric and neurological features of Huntington's chorea is described in a large family consisting of 31 members of two filial generations and the parenteral generation, of which 13 members showed manifest signs of the disease, while two further members died probably in a preliminary stage of the disease. It is of interest that a few members of the family had a large number of children, while the majority remained without offspring. Analysis of the psychiatric symptoms and signs shows that the course of the disease may take either a quiet demential, or a turbulent form. In the latter the features of manic-depressive psychosis or of schizophrenia occur, as well as a syndrome resembling psychopathic states with explosive-violent features comparable to the pseudo-psychopathia syndrome of U. H. Peters. The quiet demential course is correlated to progressive cerebral atrophy. The different forms of the turbulent course may be due to additional, genetically determined radicals of both groups of psychoses, to localized differences in the progression of the cerebral atrophy or to unspecific noxious influences from the external or internal milieu. With regard to neurological features, apart from the signs of chorea, akinesic rigidity and tic-like hyperkinesias with transition into stereotypes and primitive motor patterns were observed, as well as an apallic syndrome in the terminal phase. As a rare psychiatric variant, a syndrome characterized by compulsive pedantry combined with tic-like hyperkinesias was observed. The possibility of a striatal lesion causing motor and psychiatric impulsive features is pointed out.

Epileptic seizures in alcoholism and diagnostic value of EEG after sleep deprivation

Alcoholism and epileptic seizures frequently coincide. Two groups can be distinguished clinically and by EEG. In one group (group I), seizures occur only during a period of alcohol withdrawal or partial withdrawal and can only be explained because of alcoholism in the history of the patient. In the other group (group II), seizures occur spontaneously, as well as during alcohol withdrawal, and epileptogenic factors (residual brain damage, former epileptic seizures, and a family history of seizures) probably play an important role in the manifestation of the seizures. Paroxysms or focal abnormalities are rarely seen in group I; in group II, EEG abnormalities are seen approximately as frequently as in other epileptic conditions. Both groups were examined to determine the extent of their EEG abnormalities after 24 h of sleep deprivation. Before and after sleep deprivation, only 4% of 52 chronic alcoholic patients without epileptogenic risk factors had EEG foci. Of the 52, 2% before sleep deprivation and 8% after sleep deprivation had generalized paroxysms. Of 128 chronic alcoholic patients with additional epileptogenic factors, 19% before sleep deprivation and 24% after sleep deprivation had EEG foci, and 17% before and 28% after sleep deprivation had generalized paroxysms. The pathogenesis of epileptic seizures in both groups and the therapeutic consequences are discussed.

[The value of EEG after sleep deprivation for the diagnosis of epileptic seizures, epilepsy and other cerebral disorders]

114 electroencephalographic and 49 clinical criteria of 1010 patients, including 64 healthy volunteers, were evaluated by means of a computer. In 549 patients with epileptic seizures spike wave (sw) paroxysms were seen in 13.3%. Following a 24-hour period of sleep deprivation sw paroxysms were present in 24.2% cases which represents an increase of 82.0%. The number of cases with focal discharges increased in this group from 21.3% initially to 27.5% after sleep deprivation, representing an increase of only 29.1%. The percentage increase in sw paroxysms and focal discharges following sleep deprivation was approximately as marked also in patients without epileptic seizures, so that sleep deprivation was found to be equally useful in patients with non-epileptic cerebral disorders. The rate of activation is higher in children and juveniles than in adults. Similarly, it is higher in patients with awaking epilepsy than in patients with sleep epilepsy. The influence of sleep deprivation and that of sleep, respectively, upon the provocation of EEG changes was not sharply differentiated. By counting sw paroxysms in the EEG before sleep deprivation, in the waking EEG following sleep deprivation, as well as in the subsequent sleeping EEG further evidence was obtained, however, supporting the suggestion that special significance may be attributed to sleep deprivation as a provocation method. If the activation of sw paroxysms and focal changes is related to sleep and sleep stages it can be shown that their frequency decreases from stage 1 to stage 4. In particular, the short fluctuations in vigilance, the waking reactions frequently occurring under routine laboratory conditions and the transitions between sleep stages were seen to assume trigger functions.

[Differentiation of 2 paroxysmal reaction types in the EEG after sleep deprivation]

In the EEG after sleep deprivation paroxysms with spikes and spike wave-complexes as well as paroxysms with slow waves can be seen. The paroxysms occur either spontaneously (it means at any time during the record) or at moments of shifting vigilance. These moments are characterized by sudden changes of the EEG frequency for instance by transition from one sleep stage to another. Paroxysms with spikes or spike wave-complexes occur mainly at the transition from lower to higher levels of vigilance and are accompanied by abnormal K-complexes and abnormal photosensibility. Paroxysms of slow waves occur mainly at the transition from higher to lower levels of vigilance, abnormal K-complexes and abnormal photosensitivity are lacking but in some cases the before diffuse abnormal EEG is improved after sleep deprivation. It assumed that we are dealing with two different types of reaction.

[Sleep deprivation as activating procedure in EEG of patients with and without epileptic seizures. II. Focal discharges ]

Of 901 patients investigated 167 showed a focal disturbance in the EEG before and/or after 24-hours sleep deprivation. 459 patients suffered from epileptic seizures, the remainder had non-epileptic attacks or an organic cerebral disease without seizures. Of the 167 focal EEG changes 21.6% were seen only following sleep deprivation. In 9.6% focal changes present before could not be observed anymore following sleep deprivation. There was no significant difference between the three groups of patients mentioned above. The 24-hours sleep deprivation thus represents an activation procedure which may enhance diagnostic information relating to the question of focal EEG disturbances not only in epileptic patients. In the group of patients with epileptic seizures the activation or suppression respectively of the focal disturbance showed some dependence from seizure type and frequency as well as from the type of the focal change (spikes or slow waves). In our material the differences were however not statistically significant. More information could be gained from the waking EEG and from stage 1 than from sleeping stages 2 to 4 according to Rechtschaffen and Kales. Trigger functions could be attributed especially to the transitional phases from wakefulness to sleep and from stage 1 to stage 2 and vice versa particularly associated with arousal reactions. In our short sleep records REM stages could be rarely observed.

[Sleep deprivation as activating procedure in EEG of patients with and without epileptic seizures. I. Generalized paroxysmal discharges ]

The EEGs of 459 patients with and 442 patients without epileptic seizures showed generalized spike wave (s/w) paroxysms in 126 cases and generalized slow wave paroxysms in 63 cases before and/or after sleep deprivation. In patients with epileptic seizures s/w paroxysms appeared in 23%, whereas in patients without epileptic seizures. S/w paroxysms were present in only 5%. The difference is statistically highly significant. The frequency of generalized slow wave paroxysms showed with 6% and 8% respectively no statistical significance. In 91% of patients with s/w paroxysms the latter appeared already in the waking phases of the EEG following sleep deprivation. All s/w paroxysms which appeared in the sleep EEG were demonstrable already in stage I according to Rechtschaffen and Kales. The rate of activation of s/w paroxysms following sleep deprivation was 42% in patients with epileptic seizures, that of slow wave paroxysms was 38%. Although the number of patients with s/w paroxysms increases by approximately 100% following sleep deprivation they comprise still only 9.6% of all 459 patients with epileptic seizures. Combined with EEGs which show slow wave paroxysms or focal disturbances the incidence increases to 17%. Sleep deprivation as an activating procedure therefore provides a significant contribution to the confirmation of the diagnosis of epilepsy as well as control of therapy of epileptic patients whose routine EEG does not show typical pathological signs.

[Therapy of idiopathic facial nerve paralysis]

The aim of this study was to determine the influence of the time of onset of therapy with cortisone, antirheumatics and diuretics with respect to successful prevention of secondary lesions by compression of the nerve fibres. Onset of therapy was considered to be "in time" on all cases with incomplete facial paralysis without appearance of electromyographic signs of denervation within the subsequent three days. The results are based on 90 patients with follow-up examination out of a total of 130 patients treated. 94% of the patients thus treated "in time" showed full or almost complete remission. Only 59% of those patients in whom the therapy was not initiated "in time" showed satisfactory results. It may be concluded that the therapy of an idiopathic facial paralysis should commence at the very first clinical signs. The differing therapeutic results reported in the literature are in part due to the problem of the sufficiently early onset of therapy.

[Activities in the alpha band in unresponsive patients (author's transl)]

Activities in the alpha band are to be encountered in unresponsive patients. A review is given over the different conditions. Patients suffering from pontine lesions mostly are not comatose but locked-in. Alpha activities with intoxications and with comatose states due to transtentorial herniation can be distinguished by the accompanying neurological signs. In severe metabolic coma alpha activities are to be observed as an epileptic phenomenon. Monorhythmical alpha activities with hypoxic coma are not accompanied by slow waves, succeed a burst suppression pattern and are an ominous prognostic sign.

Quantification of the effect of epidural spinal electrostimulation (ESES) in central motor disorders

The importance of film documentation for objective and quantitative assessment of the results of epidural spinal electrical stimulation (ESES) was shown. Our experience is based on 25 patients with central motor disorders, predominantly of spinal origin. 17 were selected for internalization of a receiver system. By means of description and clinical registration of spasticity, reduced mobility, motor strength, dexterity, etc., or by means of electrophysiological tests, complex motor performance such as standing, sitting, dressing and undressing, eating and writing cannot be sufficiently evaluated. Short scenes of these activities when demonstrated by motion picture enable the therapist to compare better the condition of the patient before and with ESES, and thereby facilitate the selection of patients for internalization of receiver systems.

[Epidural spinal electrostimulation (ESES) in patients with chronic pain and central motor disturbances (author's transl)]

Epidural spinal electrostimulation (ESES), as method in the treatment of patients with chronic pain or severe central motor disturbances, especially spastic paresis of spinal origin and bladder dysfunction, is indicated when conservative measures prove ineffectual and before surgical intervention is considered. The biochemical and innervation processes which are brought about by ESES are discussed, as well as the literature on the efficacy and possible complications of the method. Twenty cases were subjected to a test stimulation and in twelve of these the stimulation system was implanted. Spinal spasticity and the range of mobility were improved by 20 to 30% in 8 patients with multiple sclerosis and 3 other patients with myelopathy of varied aetiology. In addition, spastic cramps of abrupt onset, with or without pain, disappeared almost completely following ESES in all cases. Three cases with chronic pain, two after a caudal lesion and one with cervical radicular damage, were markedly improved.

[Neurological signs in diphenylhydantoin intoxication (case reports and review) (author's transl)]

Five patients who were treated with long-term diphenylhydantoin for epilepsy developed neurological signs of poisoning. In 4 cases the symptoms appeared following treatment of status epilepticus with additional phenytoin medication. All patients had an acute symptomatic psychosis and a diffuse slowing of the curves in the EEG. All 5 patients showed cerebellar signs and two of them complained additionally of objective polyneuropathy, a third case complaining of itching only. An axonal polyneuropathy with minimal reduction in motor nerve conduction and a considerable extension of distal latency and diminution of compound action potential was found. In one case the biopsy showed concentric lamellar bodies coming from the axon, with intact myelin sheaths. All alterations were reversible. The pathogenesis of toxicity is discussed. Cumulation of toxic products in the plasma arising from delayed elimination of DPH metabolites is pointed out. However, one case with cerebellar signs had normal DPH levels.

[Hypnosis and modified hypnotherapeutic methods. Indications and results in hospitalized and ambulatory patients]

164 patients were treated hypnotherapeutically. The therapeutical methods used were heterohypnosis and the so-called gestufte Aktivhypnose (graded active hypnosis), a method which is closely related to autogenous training. In most patients independent continuation of the application of guiding principles in autogenous training was envisaged for stabilizing the results of the hypnotherapy and also achieved. The indications include a wide range of psychovegetative syndromes, including addictions. Especially syndromes showing predominantly vegetative symptoms and a relatively insignificant neurotic component responded most positively to this type of treatment. The results were less satisfactory in patients suffering from pronounced personality disorders. Hynotherapy now supplements psychotherapeutical treatment, hitherto mainly orientated to behaviour therapy, in such a way, that psychotherapy in a general hospital can be realized more effectively.

Eclampsia--monitoring of intraventricular CSF pressure

Continuous monitoring of the intraventricular CSF pressure was performed for 48 h in a woman of 23 years who had postpartum eclampsia with unconsciousness for 5 days and decerebrate spasms suggesting compression of the upper brainstem. The intraventricular pressure was normal with minor variations of 10--20 mm Hg.

[Three years behaviour therapy in a general hospital (author's transl)]

On the basis of 172 cases a report is given on the experience with behaviour therapy in a general hospital. Diagnostic and therapeutic proceedings as well as the fundamentals and methods of practically applied behaviour therapy are discussed. The results indicate that the dilemma of the so-called "healthy" discharged patients following organic thorough examination may be rendered less harmful by this proceeding.

[Chronic thallium poisoning (author's transl)]

A rare case of criminal, chronic thallium poisoning is described. In spite of the general prohibition of the cosmetics, drugs and rodent exterminators containing thallium thallium intoxications are still observed occasionally. In the reported case typical symptoms as initial pain, dryness of the skin, constipation and insomnia were missing. The clinical picture was dominated by a polyneuropathy more pronounced in the lower extremities, a lesion of the optic nerve and the psychic symptoms of organic damage. A particular feature was the early loss of sensitivity of the anterior rami of the intercostal nerves.

[EEG after sleep deprivation in patients with unequivocal and equivocal epileptic seizures, as well as no epileptic patients (author's transl)]

In 107 patients the EEG after sleep deprivation was performed. The patients have been divided in three groups: 1) with clinically unequivocal, 2) equivocal and 3) no epileptic seizures. All the patients where subdivided in those with and those without anticonvulsive medication. In patients with a previous normal EEG, sleep deprivation had the most activating effect regarding focal or generalized spikes or spike wave complexes in group one. However, patients without medication showed more often activation compared with untreated patients. In the second group the activation was less pronounced, again presenting the same relation between treated and untreated patients. Patients with no seizures as well as a control group of 20 volunteers had no activation at all.

[Influence of alcohol on photomyoclomus and photoconvulsive response (author's transl)]

In some subjects with increased light sensitivity to intermittent photic stimulation it could be observed: (1) a photomyoclonic response (PMR)--(in the EEG: muscular and ocular artefacts and probably spikes) including twitching of the facial, and sometimes muscles (Fig. 1 and 2) a photoconvulsive response (PKR), which deals in EEG with paroxismal cerebral potentials (Fig. 2). 20 min after consumation of small doses of alcohol (60 ml brandy) the PMR persists, while the photomyoclunus response gets extinguished (Fig. 3). In special terms there can be a development of epileptic seizures without alcohol (Fig. 4a-b), which fail to appear after alcohol up to 3 hours. This effect is demonstrated in six cases (Tab. 1). A partial anticonvulsive effect of alcohol is possible to be involved, especially in cases of fits with motoric actions (myoclunisms). The cilical valence of PMR and PKR seems to be the same, as a conductive factor to the liability to cerebral fits.