[Aspects of epilepsy in childhood (author's transl)]. / Aspekte der Epilepsie im Kindesalter

Between 3700 and 3900 children are admitted annually to this children's hospital. During the past four years a total of 455 children with convulsions were admitted for investigation. 255 of these cases were calcified as epilepsy, 202 as febrile convulsions and 28 as neonatal convulsions. A quarter of the epileptic children showed fits of the petit mal type. There were only 5 cases of infantile propulsive petit mal. High frequency of fits and, in particular, status epilepticus, were very rarely seen in the present study. A case of self-induced photosensitive epilepsy, later combined with psychomotor epilepsy, is referred to in detail. Of 149 children with grand mal epilepsy, 36 were classed as idiopathic, and 88 as symptomatic cases. 37 of the symptomatic cases showed focal epilepsy with generalisation. It was concluded from the clinical course and the EEG that the combined effects of familial predisposition towards fits and exogenous cerebral lesions were operative factors in 14 patients. Children with febrile, convulsions possessed an EEG suggestive of a familial predisposition towards fits in slightly more than 50% of the cases. No cause could be found for the seizures in 5 infants with neonatal convulsions, but the mother of one of these infants was an epileptic herself, undergoing treatment with anticonvulsive drugs in high dosage and a withdrawal syndrome was suspected in this particular case. 17 infants with neonatal convulsions were symptomless on leaving hospital and remained so during the first year of life. Of the remaining cases, 10 showed neurological disturbances and one died. There was only one case in which neonatal convulsions progressed directly to epilepsy. The peak incidence of the first appearance of fits occurred during the first year of life (136 children), with 18% of the entire case material presenting within the first 6 months. 108 children presented with fits for the first time during the second year of life. Thereafter, the tendency towards the development of fits for the first time in life declined with increasing age.

[The driver's license and epilepsy]. / Führerschein und Epilepsie.

Reference is made to the recommendation of the International League Against Epilepsy concerning driving-permission of epileptics, publicated 1981; only minor attention was payed to the german translation, published in 1984. Different comments on this recommendation as well as our own experiences are quoted. We refer to the rarity of traffic-crashes due to epileptic seizures, although we assume that approximately half of the seizure-patients drive, partly under concealing their disturbance. We present 51 collected own cases of traffic-accidents due to sudden attacks of unconsciousness. Only 7 of them had an epileptic seizure, 23 were caused by internal disturbances. In 18 partly young drivers there was no evident sign of sickness, although they gave rise to accidents due to a sudden attack of unconsciousness, difficult to classify. Additionally we consider the difficulty caused by ceasing therapy of seizure-free patients and driving-ability. With respect to this an own case is quoted. Also the effects of anticonvulsics on driving ability are discussed. Finally we try to develop an expertising-strategy.

[Causes and incidence of traffic accidents caused by precipitous disorders of consciousness and illnesses of drivers. A one year study in Upper Austria and Salzburg]. / Ursachen und Häufigkeit von Verkehrsunfällen infolge anfallsartiger Bewusstseins- bzw. Gesundheitsstörungen der Lenker. Eine einjährige Erhebung in Oberösterreich und Salzburg.

It was attempted to make a survey of all traffic accidents due to sudden disturbances of health on behalf of drivers, being supported by the police of Upper Austria and Salzburg. Only 26 out of a total amount of 53.530 road accidents were made known but the cooperation with the police did not always seem to work too well. Only in the province of Salzburg did the number of these accidents correspond with the expected frequencies of 1.3%. Most of the drivers were internally sick, cardiovascular diseases prevailing. The danger of epilepsy is generally overestimated, that of diabetes and other internal diseases rather underrated. People in general good health were also seen causing accidents due to nausea. In such cases self-endangering is twice as common as the exposure of others to danger. In the majority of the incidents only damage to property resulted. In addition it became apparent, that accidents with damage to people occurred more often in the city than in rural areas, whereas fatalities and severe injuries were more common in the country than in cities.

[The role of alcohol in "pyromania" and arson]. / Die Rolle des Alkohols bei "Pyromanie" und Brandstiftung.

The role played by alcohol in pyromania and arson was examined. We had a total of 103 arsonists, 95 of which were men and 8 women. 69 of the offenders had only started one fire, 34 had started more than one. 70 offenders were under the influence of alcohol at the time of the arson, 54 were alcoholics altogether. Adults were usually under the influence of alcohol, whereas adolescents were quite often not. Psychotics were generally not under the influence of alcohol. With regard to marital status, married arsonists showed the highest level of alcohol consumption. Offenders who started fires during the night were usually under the influence of alcohol, very drunk or even alcoholics. There were significant connections between the frequency and level of alcohol consumption and the number of previous convictions. Pyromania is classed as some form of psycho infantilism. In adults, it may be found in the form of an alcohol toxic regression in many different psychological disorders. However, it is found most commonly in unstable people with personality disorders.

[Circadian correlations of criminal behavior with reference to simultaneous alcoholic intoxication]. / Tageszeitliche Bindungen kriminellen Verhaltens unter Berücksichtigung einer gleichzeitigen Alkoholisierung.

In order to study the correlation between criminal acts and time of day we analyzed reports of the Federal Police Department in Salzburg covering 2 months as well as our own psychiatric expert-opinions in case of robbery and homicide. Offences against property have the same day-time rhythm as does regular labour. Alcoholic intoxication hardly occurs with offences against property, although the activity of burglars goes over into the early hours of night. Aggressive offences are commonly accompanied by alcoholic intoxication, they are mainly observed at night. Lesser aggressive offences such as maltreatment or fighting generally occur during the late afternoon until midnight. Whereas aggressive offences of alcoholized persist throughout later hours of the night. The delinquency of robbery and homicide continues into the early hours of the morning. In cases of homicide there are differences concerning the individual conflict-situation. Homicides in connection with family tragedies or partnership conflicts usually occur during the afternoon or the early evening and show just a minor connection with alcoholization. Homicides in the course of primitive conflicts appear highly correlated to alcoholization and to the night hours. In cases of homicide of mental-patients there is no general connection with alcoholization or can there be seen a day-time correlation.

[Diurnal relations of criminal behavior]. / Tageszeitliche Bindungen delinquenten Verhaltens.

In order to study the correlation between criminal acts and time of day about 900 police reports which covered a period of eight weeks were analyzed. The analysis of 561 reports which have been usuable for evaluation showed that offences against property (theft, burglary) predominantly occur during the day. The activity of burglars more often then the thieves' one goes over into the night. Aggressive offences (including robbery) are mainly observed in the evening and at night. The activity of robbers more often than the ordinary aggressive offenders' one goes over into the next morning. Alcoholic intoxication hardly occurs with offences against property but is significant as far as aggressive offences are concerned. However the day-time variation of occurrence of aggressive offences without intoxication is similar to that of intoxicated offenders.

[Homicide with special reference to alcoholic intoxication and relation to time of day]. / Uber die Tötungsdelinquenz mit besonderer Berücksichtigung von Alkoholisierung und tageszeitlicher Bindung.

112 cases of homicide (around 4%) are presented from material of approximately 3000 psychiatric expert-opinions for criminal proceedings. The data of 107 committers were usable and could be evaluated statistically. 63% of the homicides were executed, 37% were attempted. 14% of the committers were considered to be psychopaths. The circumstances surrounding the crimes were further subdivided in imitation of Rasch and especially tested for daytime linkage. 53% of the males but only a very small percentage of the female committers were alcoholized. Neither alcoholization nor personality had influence upon the success of the crime. For most of the psychotic committers the attempt failed to succeed. There was a tendency that some of the assaults were performed during night-time. This was more pronounced in alcoholized than in sober committers. No linkage to the night hours could be found neither for criminal actions of psychotics or child murder, nor for murder or robbery. In conclusion we assume that certain forms of human aggression underlie a diurnal rhythm.

[Firesetting in attempted suicide]. / Brandstiftung bei Suizidversuch.

In the course of 25 years we examined 103 arsonists psychiatrically. In 10 of these cases the firesetting was accompanied by a suicidal attempt, or was inspired by a suicidal motive. These arsonists differ from arsonists with other motives: typically suicidal arsonists are older, have a higher share of women, higher values of psychosocial burden, and different psychiatric diagnoses. Moreover, the fire ist set mainly in the own flat, revenge is seen much more frequently as an accompanying motive, and, typically, suicidally motivated arsonists do set only one single fire. Out of our 10 arsonists, 5 originally had intended to die in the flames but then ran away exasperated or were saved; this combination is termed "self-immolation" in older papers. We suggest the term "suicide in combination with firesetting" for cases, where, after having set a fire, the arsonist tries to commit suicide at a different place and with other means than fire. In 7 cases we found the motive of extended suicide, with taking along the own property; in 2 cases, along with the suicide, also intimates were intended to put to dead. One female arsonist was saved out of the fire and then, after being discharged from the hospital, tried to kill her unfaithful friend. About one half of the suicidally motivated firesetters was alcoholized at the time of their firesetting while 70% of the arsonists with other motives were alcoholized, 4 of the suicidal arsonists were alcoholics altogether, similar to the whole group of arsonists, from which, approximately, one half are alcoholics.

[Problem of classifying the commotio cerebri into severe and slight injuries (author's transl)]. / Die Problematik einer Unterteilung der Commotio cerebri in schwere und leichte Körperverletzung.

Our material of medical legal investigations backs up the theory that the time of amnesia as part of the commotio cerebri seems to be prolonged under the influence of alcohol, and that retrograde amnesia is more frequent in drunken patients. A purely contusional damage of the skull of overtired and/or drunken persons more often leads to concussion of the brain. The case histories never contained detailed information about the exact duration of unconsciousness. Therefore, the common classification of the commotio cerebri into severe or slight injuries does not seem to be justified. It should better be defined as a slight injury.

[Retrospective study of 160 children with febrile convulsions]. / Retrospektive Studie bei 160 Kindern mit Fieberkrämpfen.

In a retrospective study of 411 children with cerebral convulsions over a period of 4 years, 160 patients with febrile seizures were found. This group consisted of 94 boys and 66 girls. The main purpose of this study was to establish the age of the first convulsive fit in each child. Febrile convulsions started in the first half year, increased in the second half year and culminated in the second year of life. This age dependent appearance was explained with passive immunization by maternal antibodies so that febrile convulsions appear when these antibodies decrease. The first occurrence of febrile convulsions appeared on an average of 22.9 months, in children with recurrent febrile convulsions a little earlier with 18.2 months. The most interesting fact was that children with a family history of febrile seizures showed an even earlier occurrence of the first seizure with 14.5 months. This tendency of early incidence of febrile convulsion in the group with family history and in the group of recurrent febrile convulsions could be shown as statistically significant respectively nearly significant in comparing with the group of retarded patients. A peculiar tendency for febrile convulsions seems to be documented by recurrent seizures in the patient himself, but also by a history of febrile convulsions in other family members. Both facts may lead to a very early incidence of febrile convulsions.

["Pyromania" and arson. A psychiatric and criminologic data analysis]. / "Pyromanie" und Brandstiftung. Eine psychiatrische und kriminologische Datenanalyse.

We analyzed psychiatric and criminological data from 103 arsonists. The following criticisms of the definition of pyromania according to DSM-III-R and IDC-10 seem appropriate. First, the categoric exclusion of aggressive motives does not seem very promising, since approximately one fourth of arsonists whose firesetting is based on motives quoted in DSM-III-R may also have an aggressive motive. Second, ICD-10 gives being drunk and alcoholism as a criterion for the exclusion of pyromania. This seems untenable, since the behavior classed as pyromania is largely a product of alcohol misuse. Repeated firesetting, resulting from being fascinated by fire etc., may be less a disturbance of impulse control but rather the manifestation of a psychoinfantilism, which, supported by alcohol abuse, extends into older age. The mean age of such arsonists is slightly above 20 years. The tendency for relapses after imprisonment seems to be low; this tendency probably decreases spontaneously in older age. The mean age of arsonists with aggressive motives is a little below 30 years, those setting fire with suicidal motives have a mean age of 35, deluded arsonists have a mean age of 40 years. Concrete sexual motives are relatively rare. Approximately 50% of arsonists have a purely aggressive motive. Retaliation is a rare cause, however, since most of them do not even know the victims. One third of these persons set the fire in their own homes. Most arsonists show a personality disorder, with insecurity and narcissism predominating. Data on firesetting are to be treated with caution, since two thirds of all cases are newer resolved; one fourth of cases concern minors, and in Central Europe arsonists with rational motives are hardly ever referred to psychiatrists.

[Diurnal correlation of criminal behavior]. / Tageszeitliche Bindungen kriminellen Verhaltens.

In order to study the correlation between criminal acts and time of day we analyzed reports of the Federal Police Department in Salzburg covering 2 months as well as our own psychiatric expert-opinius in cases of robbery and homicide. Offences against property have the same day-time rhythm as does regular labour. Alcoholic intoxication hardly occurs with offences against property, although the activity of burglars goes over into the early hours of night. Aggressive offences are commonly accompanied by alcoholic intoxication, they are mainly observed at night. Less aggressive offences such as maltreatment or fighting generally occur during the late afternoon until midnight. Whereas aggressive offences of alcoholized persist throughout later hours of the night. The delinquency of robbery and homicide continues into the early hours of the morning. In cases of homicide there are differences concerning the individual conflict-situation. Homicides in connection with family tragedies or partnership conflicts usually occur during the afternoon or the early evening and show just a minor connection with alcoholization. Homicides in the course of primitive conflicts appear highly correlated to alcoholization and to the night hours. In cases of homicide of mental-patients there is no general connection with alcoholization nor can there be seen a day-time correlation.

[The status of afebrile infantile convulsions within the epilepsy spectrum--a follow-up of 55 patients]. / Die Stellung afebriler Säuglingskrämpfe innerhalb der Epilepsie--Eine Verlaufskontrolle bei 55 Patienten.

In an earlier study we observed 411 patients with cerebral convulsions, 118 of whom had the first convulsion during the 1 year of life. Among these 118 children we found 76 with afebrile convulsions. In this study we present the development and outcome in 55 patients with afebrile convulsions in the 1 year of life which could be observed for some years, most of them up to the present. In 25 infants the fits started in the newborn period, and in 30 infants after the 1 month; they were divided into groups with and without risk factors in the history. Benign neonatal convulsions were found in about one-third of children, with a good prognosis. These convulsions are divided into a dominantly inherited but rarely observed form and idiopathic benign neonatal convulsions. In contrast, among the newborns with risk factors in the history we found only half with a positive development. The results in the 30 infants with convulsions after the 1 month were similar with respect to risk factors in the history of risks. The 15 infants without risks had a good prognosis. Only 3 patients had oligoepilepsy. However, in the 15 patients with risks only 3 developed normally, 6 had no fits, but were neurologically or mentally handicapped, and 7 had fits and disability. We believe that afebrile convulsions without risk factors after the 1 month could be considered a late manifestation of benign newborn convulsions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neonatal form of a nonketotic hyperglycinemia in consanguinous parents]. / Neonatale Form einer nicht-ketotischen Hyperglycinämie bei blutsverwandten Eltern.

This is a report of the neonatal form of nonketotic hyperglycinemia with rapid progressing neurological symptoms, respiratory distress and seizures. The EEG pattern is characteristic, the ratio of cerebrospinal fluid to plasma glycine abnormally high. The result of cranial computerized tomography demonstrates also in our patient that nonketotic hyperglycinemia joins a growing list of inborn errors of metabolism associated with brain malformations. The consanguinity of parents supports the known autosomal recessive form of inheritance.