Die bakterielle Meningitis verursacht oft motorische Ausfälle, Anfälle, Hörverlust und kognitive Störungen trotz adäquater Antibiose. Streptococcus pneumoniae ist der häufigste Auslöser einer bakteriellen Meningitis des Erwachsenen und verursacht neuronale Apoptose im Hippocampus. Die Apoptose der Hippocampusneurone bei der experimentellen Pneumokokkenmeningitis war zum Teil durch Caspase-3 vermittelt und hing von der Entzündungsreaktion im Liquor ab. Sowohl Caspase-Inhibition als auch Hemmung der intrathekalen Entzündung reduzierten den neuronalen Zelltod. Jedoch konnte durch beide Therapiestrategien neuronaler Zelltod nicht komplett verhindert werden, was auf Caspase- und Entzündungs-unabhängige Zelltodmechanismen hinweist. Bakterielle Faktoren spielten eine wichtige Rolle für die neuronale Apoptose sowohl in vitro als auch in vivo. Pneumokokken induzierten neuronale Apoptose in vitro bei Abwesenheit von Entzündungszellen ohne jegliche Caspasenaktivierung. Vielmehr kam es dabei zu einem raschen intrazellulären Anstieg von Kalzium und reaktiven Sauerstoffradikalen sowie zu einer frühen Mitochondrienschädigung. Geschädigte Mitochondrien setzten den Apoptose-induzierenden Faktor AIF frei, welcher nach nukleärer Translokation zur Apoptose führte. Intrazytoplasmatische Injektion von anti-AIF Antikörpern blockierte die Apoptose. Diese Resultate belegen eine essentielle Rolle der Mitochondrienschädigung und AIF-Freisetzung bei der Pneumokokken-induzierten Apoptose. Als Haupttrigger neuronaler Apoptose konnten zwei Schlüsseltoxine sowohl in vitro als auch in vivo identifiziert werden: Pneumolysin und H2O2. Pneumolysin verursachte einen raschen Anstieg von intrazellulärem Kalzium, eine rasche Zerstörung von Mitochondrien und eine damit einhergehende Freisetzung von AIF. Kalzium-Chelation blockierte AIF-Freisetzung und Zelltod. In der experimentellen Pneumokokkenmeningitis verursachten Bakterien, in denen beide Toxine inaktiviert wurden, eine deutlich geringere neuronale Schädigung. Neue adjunktive Therapien für die Klinik könnten resultieren aus: Caspase-Inhibition, Blockade der Entzündung, anti-oxidative Strategien und Inaktivierung bakterieller Toxine. / Bacterial meningitis often causes motor deficits, seizures, hearing loss or cognitive impairment, despite adequate bacterial killing by antibiotics. Streptococcus pneumoniae is the most common cause of adult bacterial meningitis damaging the hippocampus by inducing neuronal apoptosis. Neuronal hippocampal apoptosis in experimental pneumococcal meningitis was mediated in part by caspase-3 and derived from the inflammatory response in the cerebrospinal fluid. Caspase inhibition and blocking of intrathecal inflammation significantly reduced hippocampal neuronal cell death. However, both strategies did not prevent completely neuronal death indicating caspase- and inflammation-independent mechanisms. Bacterial factors play an essential role in neuronal apoptosis both in vivo and in vitro. Exposure of neurons to live pneumococci in vitro in the absence of inflammation induced rapid apoptosis, which was not associated with the activation of caspases. Rather, apoptosis was attributed to rapid increase of intracellular calcium and reactive oxygen species and early damage to mitochondria. This was followed by the release of apoptosis-inducing factor (AIF) from the mitochondria, its nuclear translocation and apoptosis. Furthermore, intracytoplasmatic microinjection of AIF-specific antiserum markedly impaired pneumococcus-induced apoptosis. These findings indicate that mitochondrial damage and AIF play a central role in brain cell apoptosis and bacterial pathogenesis. Two key toxins of Streptococcus pneumoniae inducing apoptosis were identified in in vitro and in vivo experiments: pneumolysin and hydrogen peroxide. Pneumolysin induced increases of intracellular calcium, damage of mitochondria and release of AIF. Chelating calcium effectively blocked AIF release and cell death. Infection with pneumococci unable to produce pneumolysin and hydrogen peroxide significantly reduced damage in experimental pneumococcal meningitis. New adjunctive therapeutic strategies in clinics may result from caspase-inhibition, blocking of inflammation, anti-oxidative strategies and inactivation of bacterial toxins.

A ballistic pendulum impulse generator was used to impact networks in primary culture growing on microelectrode arrays. This approach has the advantage of imparting pure tangential acceleration insults (50 to 300 g) with simultaneous morphological and electrophysiological multichannel monitoring for days before and after the impact. Action potential (AP) production, network activity patterns, and cell electrode coupling of individual units using AP waveshape templates were quantified. Network adhesion was maintained after tangential impacts up to 300g with minimal loss of pre-selected active units. Time lapse phase contrast microscopy revealed stable nuclei pre-impact, but post impact nuclear rotation in 95% of observations (n= 30). All recording experiments (n=31) showed a repeatable two-phase spike production response profile: recovery to near reference in 1-2 hrs, followed by a slow activity decay to a stable, level plateau approximately 30-40% below reference. Phase 1 consisted of a complex two-step recovery: rapid activity increase to an average 23.6% (range: 11-34%) below reference, forming a level plateau lasting from 5 to 20 min, followed by a climb to within 20% of reference where a second plateau was established for 1 to 2 hrs. Cross correlation profiles showed changes in firing hierarchy after impact, and in spontaneous network oscillatory activity. Native oscillations were found in the Delta band (2 to 3 Hz), and decreased by approximately 20% after impact. Under network disinhibition with bicuculline, oscillations were slower (0.8-1Hz) and decreased 40% after impact. These data link network performance deficits with microscopically observable subcellular changes.

In recent years, the move toward a more holistic perspective in health care has led to social scientists investigating psychosocial factors in chronic illness, such as the different languages used by health professionals when talking about nonhealth. However, there has been little inquiry into caregivers' illness experiences of stroke and Alzheimer's disease (AD). This study therefore explores the illness experiences of seven caregivers whose spouses are stroke or AD patients. A hermeneutic approach was adopted and two relatively unstructured interviews were conducted with each caregiver. Using Kleinman's work on illness narratives as an interpretive framework, it was found that - except for people questioning the authenticity of AD caregivers' experiences - similarities in caregivers' experiences outweighed differences. All described the extent to which their lives had been damaged by the illness and their reparation attempts. Critique of the research is presented and the findings' implications for treatment are suggested / M.A. (Clinical Psychology)

In recent years, the move toward a more holistic perspective in health care has led to social scientists investigating psychosocial factors in chronic illness, such as the different languages used by health professionals when talking about nonhealth. However, there has been little inquiry into caregivers' illness experiences of stroke and Alzheimer's disease (AD). This study therefore explores the illness experiences of seven caregivers whose spouses are stroke or AD patients. A hermeneutic approach was adopted and two relatively unstructured interviews were conducted with each caregiver. Using Kleinman's work on illness narratives as an interpretive framework, it was found that - except for people questioning the authenticity of AD caregivers' experiences - similarities in caregivers' experiences outweighed differences. All described the extent to which their lives had been damaged by the illness and their reparation attempts. Critique of the research is presented and the findings' implications for treatment are suggested / M.A. (Clinical Psychology)

This research study consisted of an examination of the role played by the educational psychologist in the emotional and social rehabilitation of the TBI adolescent. A survey of the literature reveals that traumatic brain injury during adolescence negatively impacts on their adaptation, development and functioning after the acute phase of the rehabilitation process. In order to study this phenomenon, a psycho-educational perspective was utilised. An in-depth qualitative study was undertaken by means of a case study design. The two cases being presented offers the reader insight into the cases pre-morbid functioning, the accident and its aftermath, the specific traumatic brain injuries, the emotional and social problems encountered by these adolescents as well as the psychotherapeutic interventions applied by the educational psychologist in the rehabilitation process of the cases under investigation. The conclusions reached from this investigation were that traumatic brain injury during the developmental phase of adolescence, negatively impacts on the emotional and social well being of these adolescents, and that the educational psychologist plays a valuable role in the emotional and social rehabilitation of these adolescents. / Educational Studies / M. Ed. (Guidance and Counselling)

Alkohol har funnits sedan urminnes tider och är något som de flesta ungdomar och vuxna är bekanta med. Flertalet vet också att för mycket alkohol på lång sikt kan orsaka skador, framförallt på lever (fettlever) och njurar. Men inte alla vet att alkohol skadar hjärnan och kan ge kramper samt epilepsi. Alkohol har olika effekter på kroppen. Akut kan det öka den inhiberande och minska den excitatoriska signaleringen i hjärnan. Långvarigt kan det öka den excitatoriska signaleringen, minska den inhibitoriska samt öka alkoholtoleransen. I hjärnan är balansen mellan den inhibitoriska och excitatoriska signaleringen mycket betydelsefull och rubbningar kan orsaka skador som i sin tur kan orsaka krampanfall. Dessa krampanfall kan bli allvarliga och ibland dödliga. Studier kring sambandet mellan alkohol och epilepsi utförda av Samokhvalov et al. (2010), Devetag et al. (1983), Bråthen et al. (1999), Tartara et al. (1983), Bartolomei et al. (1997), Victor och Brausch (1967) och Hillbom (1980) har visat på olika resultat, men trots skillnaden i resultaten har korrelationen mellan alkohol och epilepsi varit tydlig. I studien av Devetag et al. (1983) hade 58 % av 153 alkoholister anfall icke relaterade till abstinens, alkoholinducering eller sjukdom/skada. Av 60 patienter med krampanfall var 30 stycken (50 %) icke relaterade till abstinens, alkoholinducering eller sjukdom/skada i studien utförd av Bartolomei et al. (1997). Bråthen et al. (1999)  utförde en studie på 142 alkoholister med krampanfall där 16 stycken (36 %) var icke-relaterade till abstinens, alkoholinducering eller sjukdom/skada. Vidare påvisade Tartara et al. (1983) i sin studie 30 patienter med krampanfall där 3 stycken (10 %) inte var relaterade till abstinens, alkohlinducering eller sjukdom/skada. Krampanfall som inte är relaterade till abstinens, akoholinducering eller sjukdom/skada är kluriga och svåra att utreda. Många forskare har försökt få insikt i och reda ut frågan om alkohols influens över utvecklingen av epilepsi och hur det skulle tänkas gå till. När kan alkoholrelaterade krampanfall klassificeras som epilepsi, vad innebär ett alkoholrelaterat krampanfall och vilka orsaker existerar som leder till att sådanan krampanfall uppstår. I den här litteraturstudien utreds kopplingen mellan alkoholism och epilepsi för att bättre förstå sambandet. Till studien har 20 vetenskapliga artiklar använts för att förstå vilka effekter alkohol har på kroppen, vad det innebär att ha epilepsi och hur de båda är kopplade. För att komma fram till ett svar på den framförda frågeställningen i studien, om långvarigt bruk av alkohol ger kramper och epilepsi, användes 7 studier vars undersökingar huvudsakligen fokuserat på alkoholister inlagda med krampanfall. Resultaten från de 7 studierna indikerar sammantaget att alkohol sannolikt kan orsaka epilepsi. Ingen av studierna har visat motsatsen. Långvarigt bruk av alkohol ger kramper och kan även ge epilepsi, men hur det går till är inte klarlagt. Samtidigt finns det många individer som missbrukar alkohol och som inte får epilepsi eller aldrig ens upplever ett enda krampanfall. / Alcohol has been used for drinking for many years and is a substance that is well known to most teenagers and adults. Most people also know that alcohol, when misused, can cause damage to both the liver and the kidneys but not as many people know about the damage alcohol can cause the brain. The damage that alcohol causes in the brain can lead to conditions where the patient can experience seizures, whitch can further devlop into epilepsy. Alcohol has different effects on the body. An immidiate response to alcohol is that the inhibitory signaling in the brain increases and the excitatory signaling decreases. When it comes to a prolonged misuse of alcohol the effects on the brain are the opposite and it can also increase the tolerance for alcohol. Inhibitory and excitatory signaling in the brain are essential and disturbance of those signals can be very damaging to the brain. The damages can develop and become permanent and it can also trigger different kinds of seizures. The seizures can in turn become very serious and fatal. Studies on the connection between alcohol and epilepsy has been conducted by Samokhvalov et al. (2010), Devetag et al. (1983), Bråthen et al. (1999), Tartara et al. (1983), Bartolomei et al. (1997), Victor och Brausch (1967) och Hillbom (1980) and have shown different results. The results however have shown a clear correlation between alcohol and epilepsi. In the study performed by Devetag et al. (1983) 58 % of 153 patients experienced seizures not related to alcohol withdrawl, alcohol induction or injury/disease. Of 60 patients who presented seizures in the study conducted by Bartolomei et al. (1997), 30 (50 %) had seizures not related to alcohol withdrawl, alcohol induction or injury/disease. A study performed by Bråthen et al. (1999) showed  16 patients (36 %) of 142 with seizures not related to alcohol withdrawl, alcohol indiction or injury/disease. Furthermore, a study conducted by Tartara et al. (1983) showed 30 patients with seizures, where 3 (10 %) of them were not related to alcohol withdrawl, alcohol induction or injury/disease. Seizures not related to alcohol withdrawl, alcohol abuse or injury/disease are difficult to investigate. Many scientists have tried to get insight in as to how alcohol can influence the ethiopathogenesis of epilepsy. What is alcohol-related seizures, what is the cause behind the seizures and how does one decide if the seizures can be defines as epilepsy. This literature review investigates the link between alcoholism and epilepsy to better understand this connection. The question of issue was ”if prolonged misuse of alcohol can lead to epilepsy” and to unravel the question, 7 studies were used. The studies main focus was alcoholism and seizures. The results from the studies indicated in total that alcohol prabably can cause epilepsy since none of the studies showed the opposite. A prolonged misuse of alcohol can lead to seizures and even epilepsy, but how this comes to be is not clear and needs to be properly investigated. Not to forget, some people who misuse alcohol do not get epilepsy and some never experience even a single seizure.

Para avaliar a audição em crianças com paralisia cerebral foi realizada a avaliação comportamental, eletroacústica e eletrofisiológica em 61 sujeitos na faixa etária de três a seis anos e 11 meses, subdivididas em grupo experimental e controle. Foram observadas diferenças estatisticamente significantes na comparação entre os resultados obtidos nos dois grupos, bem como na comparação dos procedimentos no grupo experimental. Existe uma diversidade nos resultados dos procedimentos audiológicos em crianças com paralisia cerebral, o que torna importante a aplicação da bateria completa na determinação do perfil audiológico destas crianças. / In order to evaluate the hearing of children who have cerebral palsy disease the behavioral, eletroacoustical, electrophysiological evaluations were done in 61 people between three and six years and 11 months old, subdivided in experimental and control group. There were statistically significant differences when comparing the results obtained in both groups, as well as when comparing the procedures in the experimental group. There is diversity in the results of hearing procedures in children with Cerebral Palsy, which stresses the importance of a full battery of exams for determining the hearing profile of these children.

A assistência aos pacientes com doenças neurológicas de longa duração não é reconhecida na produção científica brasileira; entende-se por doença neurológica de longa duração: doenças neurológicas de curso longo, fase final de difícil identificação, com sintomas variados e condição de dependência moderada ou grave e comprometimento cognitivo de difícil avaliação. Neste estudo, foram consideradas as seguintes condições: estado vegetativo persistente, estado mínimo de consciência e síndrome do encarceramento (ou síndrome de locked-in). Em busca bibliográfica, verificou-se que não há artigo em língua portuguesa sobre o tema. No cotidiano, a assistência é focada em higiene e observação clínica. Entretanto, na perspectiva do Cuidado, algo mais é necessário ao se pensar este tipo de prática, para a promoção da dignidade humana. Os objetivos deste estudo são: relatar uma prática junto a pessoas com doenças neurológicas de longa duração focada no seu resgate biográfico, e fundamentar a mesma de maneira interdisciplinar, a partir do Cuidado como categoria reconstrutiva. É uma pesquisa qualitativa, na qual foram utilizados primariamente registros de um diário de campo da primeira autora, sobre intervenções em Terapia Ocupacional com esta população; a partir destes, foram produzidas narrativas e reflexões sobre a metodologia de intervenção. A partir do resgate biográfico, busca-se resgatar a condição de sujeito do paciente neurológico muito grave. Na segunda etapa, tem-se a fundamentação teórica numa perspectiva interdisciplinar; o conceito de Cuidado é a referência principal, compreendido como o sentido existencial da experiência de adoecimento. Também foi utilizado o referencial da psicanálise de orientação freudiana e lacaniana para aprofundamento teórico dos achados empíricos descritos através de narrativas. A reconstrução da biografia do paciente ocorre por diversas perspectivas, mas especialmente pela estimulação sensorial - não com foco de recuperação neurológicas, mas a partir do repertório do paciente e em busca da validação de sua condição de sujeito. Junto com uma detalhada avaliação e acompanhamento, o terapeuta faz um monitoramento contínuo, propondo atividades e dando especial atenção ás reações observadas, para que possa nomeá-las ou traduzi-las, bem como discriminar os estímulos agradáveis e desagradáveis; isto também possibilita ampliação das possibilidades de encontro deste sujeito com o mundo. Os conceitos psicanalíticos: estágio do espelho, real, lalíngua e constituição do sujeito apresentam-se como fundamentais para a compreensão das experiências empíricas vividas e, posteriormente, elaboração de uma fundamentação teórica. Memória, história, identidade, dignidade e subjetividade qualificam a prática junto a pessoas com doenças neurológicas de longa duração. A despeito das reações neurológicas apresentadas, tal prática possibilita a reconstrução de um cotidiano significativo e as teorias psicanalíticas de orientação freudiana e lacaniana constituem importante marco para fundamentação da reconstrução da assistência / The care of people with Long Term Neurological Conditions (LTNC) isn´t recognized in the Brazilian Palliative Care scientific production; in daily basis, the assistance is focussed on hygiene´s care and clinical observation. However, from the perspective of palliative care, something more is needed, to promote the dignity of the human person. To describe an occupational therapy intervention for patients with LTNC based on biographical rescue. Records and field diaries of an Occupational Therapy intervention promoted by the first author were used to produce narratives and reflections about this intervention´s methodology. The concept of Comprehensive Care is the main reference, designed as care interested in the existential sense of the illness process. It was also used the framework of Freud´s and Lacan´s psychoanalysis for theoretical studies of the empirical findings reported through narratives. The beginning of the reconstruction of the patient´s biography occurs by several perspectives, especially through sensory stimuli related to prior patient´s occupational repertoire. Along with the detailed evaluation, the therapist does a careful and continuous monitoring, proposing activities, giving special attention to their reactions, being able to discriminate what pleases or not, and expanding the possibilities of encounter of people with LTNC and the environment which surround them. The psychoanalytic concepts: mirror stage, real, lalangue and subject´s constitution had major importance to understand the empirical experiences and to develop a theoretical basis. Memory, history, identity, dignity, and subjectivity qualify the practice of occupational therapist with people with LTNC. Regardless of neurological reactions presented by the patients this practice helps reconstructing the meanings of the daily life of person with so severe disability. Sensory stimuli are shown as potential tools for a reconfiguration of the assistance with someone seriously affected by a neurological disease. Psychoanalytic theories of Freudian and Lacanian orientation are also an important framework for the reconstruction assistance

Studien fokuserar kommunikation mellan vuxna personer med grav förvärvad hjärnskada och deras närstående. Syftet är att med utgångspunkt från de närståendes berättelser beskriva hur kommunikationen manifesteras, samt att ge en teoretisk beskrivning av vilka faktorer som understödjer respektive motverkar kommunikationen. Elva gravt hjärnskadade personer ingår i studien. Orsaken till hjärnskadan är stroke, traumatisk hjärnskada eller syrebristskada. Personernas ålder varierar från 16 till 64 år vid skadetillfället. Samtliga har som en följd av hjärnskadan grava språkstörningar och kognitiva funktionshinder. Datamaterialet baseras på intervjuer och videofilm. Den teoretiska utgångspunkten är symbolisk interaktionism och den metod som används är grundad teori. Resultatet presenteras i en empiriskt grundad teoretisk modell för hur kommunikation hos studiens aktörer manifesteras. Kommunikationsmodellen innehåller kärnprocessen, kommunikationsnycklar. De öppnande nycklarna består av inledande och vidmakthållande faktorer, samt av den betryggande faktorn. Den senare får stor betydelse, utan den kommer inte kommunikationen till stånd. Resultatet diskuteras i förhållande till sociala kommunikationsteorier och begreppet kommunikativ kompetens. Teorin förväntas ge de närstående stöd i hur de förhåller sig i mötet med en person som har ett kommunikativt funktionshinder. / This study focuses on communication between adults with severe acquired brain damage and persons close to them. The purpose of the study is to describe, on the basis of accounts given by caregivers, the caregivers are referred to as relatives and personnel, how communication is manifested and to provide a theoretical description of the factors that facilitate or hinder communication. Eleven persons with severe brain damage are included in the study along with their caregivers. The brain damage has been caused by stroke, traumatic brain injury or lack of oxygen and in all cases has resulted in severe language impairment and cognitive disabilities. Age at time of injury varies from 16 to 64 years. The empirical material consists of interviews and video film. The theoretical framework applied is Symbolic Interactionism and the method used is Grounded Theory. The results are presented in the form of an empirically grounded theoretical model of how communication is manifested in the context of the study. This model comprises the core process and the communication keys. The keys are the introductory and maintaining factors as well as the confidence factor. The confidence factor has great significance; without it, communication cannot be established. The results are discussed in relation to theories of social communication and the term communicative ability. It is expected that application of the theory can make it easier for caregivers to interact with persons with severe communicative disability.

Thesis (doctoral)--University of Limburg, Maastricht, 1992. / Summary in Dutch. Includes bibliographical references (p. 109-119)