Modern Problems of Pharmacopsychiatry Modeme Probleme der Pharmakopsychiatrie Problemes actuels de pharmacopsychiatrie

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1 Modern Problems of Pharmacopsychiatry Modeme Probleme der Pharmakopsychiatrie Problemes actuels de pharmacopsychiatrie Vol. 4 Edited by - Herausgegeben von - Dirige par F. A. FREYHAN. New York N. PETRILOWITSCH. Mainz P. PICHOT. Paris lt~ S. Karger Basel (Switzerland) New York

2 Epilepsy Recent Views on Theory, Diagnosis and Therapy of Epilepsy Grundlagen, Diagnose und Therapie der Epilepsie in neuer Sicht Nouveaux aspects pathophysiologiques, diagnostiques et therapeutiques de l'epilepsie

3 Epilepsy Recent Views on Theory, Diagnosis and Therapy of Epilepsy Grund1agen, Diagnose und Therapie der Epi1epsie in neuer Sicht Nouveaux aspects pathophysio1ogiques, diagnostiques et therapeutiques de l'epilepsie Edited by - Herausgegeben von - Dirige par E. NIEDERMEYER, Baltimore 40 fig., 40 tab. lt~ S. Karger Basel (Switzerland) New York 1970

4 At a reduced price for subscribers to 'International Pharmacopsychiatry' Zum ermassigten Preisfiir Abonnenten der «Internationalen Pharmakopsychiatrie» A prix reduit pour les abonnes a «International Pharmacopsychiatry» Previous volumes Modem Problems of Pharmacopsychiatry Vol. 1: Clinical Psychopharmacology jklinische Psychopharmakologiej Pharmacologie Clinique X p., 26 fig., 27 tab., 1968 Vol. 2: The Thioxanthenes X p., 27 fig., 12 tab., 1969 Vol. 3: Depression: Its Diagnosis and Treatment Lithium: The History of its Use in Psychiatry XIII + 92 p., 14 tab., 1969 S. Karger AG, Arnold-Bocklin-Strasse 25, 4000 Basel 11 (Switzerland) All rights, including that of translation into other languages, reserved. Photomechanic reproduction (photocopy, microcopy) of this book or parts thereof without special permission of the publishers is prohibited. Copyright 1970 by S. Karger AG, Basel Printed in Switzerland by Buchdruckerei National-Zeitung AG, Basel Blocks: Steiner & Co., Basel

5 Index Preface VII MORRELL, F. (palo Alto): Cellular Pathophysiology of Focal Epilepsy 1 WALKER, A. E. (Baltimore): The Propagation of Epileptic Discharge. 13 BANcAUD, J. et TALAIRACH, J. (Paris): L'electro-encephalographie de profondeur (Stereo-electro-encephalographie dans l'epilepsie) PEIFFER, J. (Tubingen): Zur Neuropathologie der Epilepsie METRAKOS, J. D. and METRAKOS, K. (Montreal): Genetic Factors in Epilepsy PASSOUANT, P. et CADILHAC, J. (Montpellier): Decharges epileptiques et sommeil RODIN, E. A. (Detroit): Grand Mal Seizures and Visual Evoked Responses 105 KUHLO, W. (Freiburg i.br.): Petit-mal-Epilepsie NIEDERMEYER, E. (Baltimore): Common Generalized Epilepsy and Generalized-synchronous Seizure Discharges SERAFETINIDES, E. A. (Oklahoma City): Psychiatric Aspects of Temporal Lobe Epilepsy WIKLER, A. and ESSIG, C. F. (Lexington): Withdrawal Seizures Following Chronic Intoxication with Barbiturates and other Sedative Drugs VICTOR, M. (Cleveland): The Role of Alcohol in the Production of Seizures 185 HESS, R. (Zurich): Die epileptogenen Himtumoren LIVINGSTON, S. (Baltimore): General Principles of Drug Therapy of Epilepsy 232 DOOSE, H. (Kiel): Spezielle Probleme der antikonvulsiven Therapie GASTAUT, H. (Marseille): Exceptional Anticonvulsive Properties of a New Benzodiazepine (Demonstrated by a Screening Method) ITIL, T. M. (St. Louis): Convulsive and Anticonvulsive Properties of Neuro- Psycho-Pharmaca RASMUSSEN, Tw. (Montreal) : The Neurosurgical Treatment of Focal Epilepsy 306 DENNERLL, R. D. (Detroit): Problems of Rehabilitation and Employability in Epilepsy

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7 Preface With the passing of centuries the notion of epilepsy has changed from a horrifying und awe-inspiring supranatural event into a multi-etiological clinical reaction and an abnormal neurocellular response. This response with its electrophysiological and behavioral concomitants cuts through many areas of medicine but in spite of the multitude of causes and triggering factors, a unifying band connects those various epileptic conditions and convulsive disorders; the uniqueness of epileptic phenomena still permits the use of the term 'epilepsy'. Whoever uses this word in medical language should be aware of the multiplicity of epileptic conditions and also of a common denominator which lies mainly in the chemistry and electrophysiology of the basic paroxysmal process. A rather small volume like this one is certainly unable to cope with the whole width of epileptology. It should be kept in mind that this series of publications has dealt mainly with neuro-psycho-pharmacological subjects and it is therefore obvious that attention had to be paid to the therapeutic aspetcs of convulsive disorders. This is reflected by the fact that both the general principles and the special problems of anticonvulsive therapy are presented in different articles; moreover, one contribution is entirely dedicated to the action and effects of the benzodiazepines which have brought forth some revolutionary changes in certain fields of epileptology. When anticonvulsive treatment fails, however, neurosurgery might be considered and for this reason, an authoritative paper on the surgical treatment of epilepsy has been added. The ultimate goal of any type of treatment is psychological and social rehabilitation; the problems involved in this process are presented in a separate article. The limitation of space and the basic pharmacological character in this series of volumes prompted a few more peculiarities. A paper on the convulsive and anticonvulsive properties of 'neuro-psycho-pharmaca' will

8 VIII Preface hopefully add another special flavor to this volume since this topic is rather seldom discussed. It also appeared to be necessary to include the subjects of barbiturate withdrawal seizures and alcohol epilepsy, not merely because of the emphasis of pharmacology but also in view of the great general interest in these topics. Other subjects were chosen because of their increasing significance in recent years: depth electro-encephalography, the correlation of seizure activity and the various stages of nocturnal sleep, the role of genetics and the psychiatric implications of temporal lobe epilepsy. The neoplastic etiology of epileptic seizures has been included in this volume since tragic mistakes may result from misdiagnosed epileptogenic brain tumors. The experimental neurophysiological aspects could not be given the coverage which they truly deserve. Studies of the microelectrophysiology within the epileptic focus and the propagation from the focus into other cerebral regions will confront the reader with two selected areas of basic epileptology. A presentation of neuropathological views of convulsive disorders shows clearly that this branch of the neurological sciences is joining forces with biochemistry, neuropharmacology and neurophysiology since morphology alone can hardly shed further light on epileptic mechanisms. The clinical seizure manifestations of Grand mal and Petit mal are dealt with in two papers. It is most intriguing to presume that there might be a gamut of Grand mal attacks: those with full participation of cortical cells (and obliterated evoked responses during the seizure) and those with incomplete cortical seizure activity. This concept could stimulate the psychiatrist who sometimes cannot help wonder why electroconvulsive treatment does not fulfill the expectations in supposedly ideal cases. As to Petit mal, this well delineated type of seizure may occur in prognostically different conditions. In order to present a refreshing and modern view of the convulsive disorders, articles dealing with the present status of a certain topic are deliberately mingled with articles based entirely on the author's personal investigative work. It is hoped that these apparent inconsistencies will turn out to be beneficial to the majority of readers. The reader will also realize that no monolithic view is offered in this book and that the positions of some authors might even be diametrically opposed. This should be warmly welcomed since a unitarian approach may stifle all progress. Epilepsy looks different from the geneticist's and the neurosurgeon's angle of view; in fact, the view is different from various adjacent mountain peaks although many details of the panorama may be the same. E. NIEDERMEYER