J.Jpn. Surg. Soc.. 57(12): 2083-2094, 1957
STUDIES ON EPILEPSY AND THE VASOMOTOR ACTIVITY
(STUDIES ON THE VASOMOTOR ACTIVITY IN NORMAL AND PATHOLOGICAL STATES, REPORT Ⅳ.)
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1st Surgical Department, Tokyo University School of Medicine (Director: Prof. Kentaro SHIMIZU) Chikao NAGASHIMA |
2) By means of photoelectric plethysmography, skin temperature measurement, pneumography, pressure pulse and blood pressure recording, the author studied the peripheral vasomotor activity together with systemic hemodynamic changes through pre- and postictal and interseizure periods.
3) The volume pulse and vasomotor reflexes to various stimuli, were studied in the finger-tips bilaterally, with the patient in supine position.
Skin temperature was measured in the finger-tip, dorsum of the proximal phalanx of the third finger and dorsum of the hand, bilaterally.
4) The examination was performed in every stage of the interseizure period. In 27 cases the records were continuously made until the natural seizures occured.
5) In petit mal (absence), neither vasoconstriction nor vasodilatation was found except for postictal transient vasoconstricicon, which proved to be a reflectory vasoconstrictor response as shown by simultaneous G.S.R. tracing.
6) In myoclonic petit mal, the vasoconstriction preceded the clinical seizur.
7) In psychomotor epilepsy, the rythmic fluctuation between vaso-constriction and dilatation became more marked before the clinical seizure. The intensive vasodilatation occured in the finger-tip which was obviously noted by increased volume pulse and marked skin temperature rise in the finger-tip. Whereas, the temperature of dorsum of the hand and proximal phalanx rose more slowly and was much lower than that of the finger-tip.
These phenomena were a lso observed in so-called “autonomic epilepsy” and in some cases of focal convulsive seizures. It may be inferred from the results that the preictal vasodilatation was brought about by openning of arterio-venous anastomoses of the finger-tip which might be caused by central vasodilator innervation.
8) The vasomotor reflexes became refractory to various stimuli, as the clinical psychomotor seizure approached.
Constrictor responses were abolished in the following order : at first, those to cold or pain, then to startling sound or deep breathing and finally, just before the seizure to mental arithmetic or recalling memory.
It may be inferred from the process, that, refractory state of vasomotor reflex is brought about by central inhibitory mechanism caused by preictal cortical neuronal discharge.
9) In generalized convulsive seizure, vasoconstriction preceded the clnical seizure.
10) In focal convulsive seizure, mark d difference was noted, at least in some cases, between finger tips of both sides, concerning skin temperature, volume pulse amplitude, in the preictal as well as in the interseizure period. In other words, either vasoconstriction or vasodilatation was found on the side contralateral to the focus.
11) In so-called “autonomic epilepsy”., vasodilatation and hypotension preceded the seizure.
12) The results are summarized as follows: epilepsy can be classified into 4 groups from the view point of vasomotor activity.
(i) Epilepsy with normal vasomotor activity: petit mal (absence).
(ii) Epilepey with vasodilatatory tendency: psychomotor seizure and so-called “autonomic seizure”.
(iii) Epilepsy with vasoconstrictor tendency: generalized convulsive seizure with or without other types of epilepsy.
(iv) Epilepsy with either vasoconstrictor or vasodilatatory tendency: focal convulsive seizure.
13) The cutaneous arterio-venous anastomoses in the finger-tip receive central vasodilator inneration.
(author's abstract)
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