B. van Sweden

Periodic EEG Discharges in Psychiatry

Periodic EEG discharges are signs of severe CNS dysfunction. In psychiatry they usually indicate presenile dementia of the Jacob-Creutzfeldt type. Psychiatric patients are presented in whom the occurrence and EEG features of diffuse and lateralized periodic discharges are discussed. It appears that toxic conditions other than acute barbiturate intoxication, such as drug withdrawal states and psychotropic drug overdosage, represent important etiological factors for inducing periodic EEG discharges. Their relation to clinical signs such as epileptic symptoms, metabolic dysfunction, and disturbance of consciousness is particularly stressed and related to current literature data.

Part II The EEG in alcohol addicts presenting with seizures

Abstract It is an old and yet unsolved question whether epilepsy occurring in alcoholism should be classified as an electroclinical disease entity. There are but few arguments in favour of this concept. The diagnostic significance of the EEG has often been neglected. However some EEG features favour the interpretation of EEG discharges as the electrical expression of a transient cerebral state resulting from temporary overexcitability following alcohol withdrawal without strict relationship to clinical seizures. The clinical relevance of trigger mechanisms such as photostimulation and particularly sleep deprivation as an activation procedure for the induction of psychosis and seizures is critically reviewed. Tissue hypoxidosis and metabolic dysfunctions, occurring in syndromes of impairment in alcoholism, also play an important part in favouring seizures of a different electro-clinical nature.

The EEG in chronic alcoholism partI the EEG in alcohol addicts presenting with psychosis

Abstract The EEG has only rarely been considered in discussions on psychosis in alcoholism. The main topic of this paper is the question whether the EEG is capable of revealing elements for elucidating the pathophysiology of some of the psychotic conditions or symptoms occurring in alcoholism. Although EEG abnormalities are a-specific in nature and no particular EEG signs may be consistent with psychosis, some types of EEG patterns are more frequently observed in certain clinical conditions such as delirium tremens and amnestic-confabulatory states. Taking these ‘common’ EEG-patterns into account, it may be possible to use the EEG as a diagnostic tool in differentiating between clinical psychopathological syndromes. The pathogenetic importance of tissue hypoxidosis for the development of psychosis in alcoholism is discussed.

Are Complex Partial Seizures an Uncommon Withdrawal Sign in the Elderly

An elderly female alcohol and benzodiazepine addict presented with an atypical amnestic episode. Five days later she showed several complex partial seizures as main signs of a withdrawal state. The value of the EEG in the differential diagnosis of amnestic syndromes is emphasized. Temporolimbic involvement in withdrawal states is discussed and our ignorance regarding drug dependence and withdrawal in the elderly is stressed. It is suggested that late-onset partial seizures with unknown etiology in the elderly might be more often related to drug dependence than generally accepted.

The EEG in hypnosedative drug withdrawal and dependence

SummaryCompulsive hypnosedative drug use is commonly associated with the development of tolerance and physical dependence. As most data are derived from human or animal experiments, electroclinical correlations in the clinical field are rather scarce. The informative value of the EEG features registered in 22 patients presenting minor and/or major signs of a clinical hypnosedative drug withdrawal syndrome are discussed. The electroclinical correlations are investigated and the physiopathogenesis of both clinical and EEG dysfunction are related to the neurochemical theory of dependence and withdrawal. It is suggested that the drug withdrawal syndrome represents a transient unbalanced metabolic state at the neuronal cellular level, which may be included among the causes of metabolic encephalopathies. The severity of this encephalopathy and the moment at which it occurs depend on both exogenous and personal factors.

EEG dysfunction in geropsychiatry

Electro-clinical correlations are reported in 200 elderly patients admitted to a psychiatric ward of a general hospital. Normal EEG characteristics were generally associated with functional psychiatric disorder. Abnormal EEG features correlated with organic brain syndromes (O.B.S.). The diagnostic and pathogenetic considerations and restrictions of EEG foci, intermittent rhythmic delta activity (Irda) and diffuse EEG slowing are discussed. The informative value of EEG dysfunction in geropsychiatry is emphasised.

Drug-induced repetitive sharp EEG discharges in multi-infarct dementia

Elderly patients are usually more susceptible to and more often show adverse drug reactions. Repetitive sharp EEG transients, reversible upon withdrawal of neuroleptic drugs, are reported in clinical

Cerebral Malignancy in Psychiatry: EEG Aspects

The prevalence of cerebral malignancy in psychiatric patients is investigated in our own clinical material and compared with literature data. The importance of cellular type and localization of the lesion is checked and related to clinical symptoms such as seizures and psychopathological symptoms. The recognition of cerebral malignancy in psychiatric patients, especially in the early stages when few or no neurological signs are present, is shown to be a complex clinical problem. The possibilities and restrictions of technical investigations in general and of the EEG in particular are stressed.

Para-infectious encephalopathies in childhood EEG-aspects and familial occurrence

The authors report on infectious-allergic encephalopathy, occurring in a nine-year old boy. The clinical picture is that of a generalized myoclonic epileptic state. The EEG shows bilaterally occurring stereotyped rhythmic complexes with a short interval. The child recovered completely. The diagnostic value of periodically occurring EEG-features and the familial occurrence of para-infectious encephalopathies are discussed.