Biografieforschung: theoretische Perspektiven und methodologische Konzepte für eine re-konstruktive Geschlechterforschung

Die Biografieforschung bezeichnet einen komplexen Forschungsansatz, der auf eine lange Geschichte des wissenschaftlichen Interesses an "persönlichen Dokumenten" verweisen kann. Sie ist eine voraussetzungsvolle Forschungsperspektive, die sich in zentralen Aspekten ihres Vorgehens auf Biografien als theoretisches Konzept, als historisch-empirischen Gegenstand und als komplexe methodologische Strategie bezieht. Andere Begriffe, welche oftmals synonym gebraucht, in der Biografieforschung aber systematisch unterschieden werden, sind "Lebensgeschichte" und "Lebenslauf". Die Autorin skizziert die Perspektiven einer rekonstruktiven Geschlechterforschung innerhalb der Biografieforschung, wozu sie auf die Differenzierungen empirischer Forschung, die methodologischen Prinzipien sowie auf Datenerhebung und Datenanalyse eingeht. Sie hebt insbesondere drei Kontextrelationen bei der Interpretation eines biografischen Textes hervor: Biografie, Interaktion, kulturelle Muster und soziale Regeln. Das skizzierte Konzept von Biografieforschung begreift sie als ein offenes Programm, das vielfältige Anknüpfungspunkte zu aktuellen theoretischen Diskussionen in der Geschlechterforschung aufweist. (ICI2

Neonatale Anfälle und ihre Behandlung

Die Diagnose und Therapie neonataler Anfälle stellen auch für erfahrene Neonatologen oder pädiatrische Epileptologen eine Herausforderung dar. Eine Unterscheidung zwischen epileptischen Anfällen und paroxysmal auftretenden Bewegungsmustern oder -automatismen ist ohne gleichzeitige EEG-Aufzeichnung oft sehr schwierig. Fehlinterpretationen führen immer wieder zu einer Fehlbehandlung. Die Erkenntnis, dass Anfälle bei Neugeborenen mit akuter neurologischer Pathologie zu weiterer zerebraler Schädigung führen und die Entwicklungsprognose negativ beeinflussen können, macht eine rasche Diagnostik und Therapie erforderlich. Publizierte Therapiekonzepte beruhen auf den langjährigen Erfahrungen mit den etablierten Medikamenten wie Phenobarbital und Phenytoin. Von den neueren Medikamenten beginnt sich Levetiracetam zu etablieren. Dieses Medikament wird seit kurzem im Behandlungsprotokoll des Kinderspitals Zürich als Mittel der 1. Wahl eingesetzt. Für alle zur Therapie neonataler Anfälle eingesetzten Medikamente gilt, dass Studien der Evidenz-Klassen 1 und 2 bezüglich ihrer Wirksamkeit und Tolerabilität fehlen. Die Therapie wird nicht selten mit für diese Altersgruppe nicht zugelassenen Substanzen, also „off-label“ durchgeführt. Randomisierte kontrollierte Studien sind aber nötig, um risikoarme und wirksame Therapieprotokolle für Anfälle im Neugeborenenalter zu etablieren

Zerebrale Anfälle bei Kindern und Jugendlichen

Zerebrale Anfälle sind im Kindesalter häufig. Neben einer suffizienten Behandlung sind eine diagnostische Einordnung anhand der Anamnese und der Anfallssemiologie sowie der Ausschluss beziehungsweise das Erkennen von Differenzialdiagnosen elementar

Modified Atkins diet is an effective treatment for children with Doose syndrome

OBJECTIVE: Children with myoclonic astatic epilepsy (MAE; Doose syndrome) whose seizures do not respond immediately to standard antiepileptic drugs (AEDs) are at high risk of developing an epileptic encephalopathy with cognitive decline. A classic ketogenic diet (KD) is a highly effective alternative to AEDs. To date, there are only limited data on the effectiveness of the modified Atkins diet (MAD), which is less restrictive and more compatible with daily life. We report findings from a retrospective study on 30 MAE patients treated with MAD. METHODS: Four participating centers retrospectively identified all patients with MAE in whom a MAD had been started before June 2015. Seven children were recruited from a cohort included in an open prospective controlled trial. A retrospective review of all available charts was performed in the other patients. RESULTS: Thirty patients (24 boys) were included. Mean age at epilepsy onset was 3.1 years (range 1.5-5.6). MAD was started at a mean age of 4.5 years (range 2.2-9.1) after the children had received an average of six different AEDs (range 2-15). Mean MAD observation time was 18.7 months (range 1.5-61.5). Twenty of 30 patients were still on MAD at the end of study (duration range 1.5-61.5, mean 18.5 months). MAD was stopped without relapse in three patients after sustained seizure freedom for >2 years. For the other seven cases, ineffectiveness (three patients), loss of efficacy (two), or noncompliance (two) led to termination. No severe adverse effects were noted. By the end of the observation period, 25 (83%) of 30 patients experienced a seizure reduction by ≥50% and 14 (47%) of 30 were seizure-free. None of the evaluated factors differed significantly between the groups of seizure-free and non-seizure-free children. SIGNIFICANCE: MAD is an effective treatment for MAE. It should be considered as an alternative to AEDs or the more restrictive classic ketogenic diet

Postoperative amplitude-integrated electroencephalography predicts four-year neurodevelopmental outcome in children with complex congenital heart disease

OBJECTIVES: To evaluate the predictive value of pre- and postoperative amplitude-integrated electroencephalography (aEEG) on neurodevelopmental outcomes in children operated for congenital heart disease (CHD). STUDY DESIGN: Prospectively enrolled cohort of 60 infants with CHD who underwent cardiac surgery with cardiopulmonary bypass in the first 3 months of life. Infants with a genetic comorbidity were excluded. aEEG was assessed for 12 hours pre- and 48 hours postoperatively. Background pattern was classified by the use of standard categories, and the presence of seizures and sleep-wake cycles (SWCs) was noted. Outcome at 1 and 4 years of age was assessed with standardized developmental tests. RESULTS: Preoperatively, infants either showed continuous normal voltage (n = 56) or discontinuous normal voltage (n = 4). Postoperatively, abnormal background pattern (flat trace, burst suppression, or continuous low voltage) was detected in 7 (12%), discontinuous normal voltage in 37 (61%), and continuous normal voltage in 16 (27%) infants. Nineteen infants (32%) did not return to normal SWCs within the recording period. Seizures were detected in 4 infants preoperatively and in another 4 postoperatively. After we controlled for surgical and postoperative risk factors, abnormal postoperative background pattern and lack of return to SWCs independently predicted poorer intelligence quotient at 4 years (P = .03 and P = .04 respectively) but was not related to motor outcome. CONCLUSION: aEEG is a useful bedside tool that helps to predict outcome in infants undergoing open-heart surgery for CHD. Abnormal postoperative background pattern and lack of return to SWCs are markers for subsequent impaired cognitive development

Does amplitude-integrated electroencephalogram background pattern correlate with cerebral injury in neonates with hypoxic-ischaemic encephalopathy?

AIMS To determine the correlation between amplitude-integrated electroencephalogram (aEEG) background pattern and cerebral magnetic resonance imaging (MRI) in infants with hypoxic-ischaemic encephalopathy (HIE) and to examine whether the correlation changes with therapeutic hypothermia. METHODS We included 38 term-born infants with HIE of whom 17 were cooled. All were continuously monitored with aEEG. Background pattern was scored at the beginning and the end of the recording. Cerebral MRI was obtained on median day 5 (2-11 days). Abnormalities were classified using a predefined scoring system for basal ganglia, watershed and overall injury, and then grouped into mild-moderate and severe. RESULTS Abnormal aEEG background pattern correlated with more severe cerebral injury on MRI in the non-cooled infants (P < 0.01). In addition, cooled infants had less severe cerebral injury than non-cooled infants, in particular on T2-weighted images (watershed P = 0.04 and total injury score = 0.07). CONCLUSIONS Abnormal aEEG background pattern is predictive of abnormal MRI, but therapeutic hypothermia seems to reduce this association. Thus, when cooling is applied in a clinical setting, the predictive value of aEEG may be limited

Hippocampal sclerosis and chronic epilepsy following posterior reversible encephalopathy syndrome

Chronic epilepsy has rarely been reported after posterior reversible encephalopathy syndrome (PRES) and the association with hippocampal sclerosis has been suggested only once before. We report the case of a girl admitted at the age of 8 years with idiopathic nephrotic syndrome. On the second day of admission, she presented with focal complex seizures and cerebral MRI showed posterior encephalopathy and no hippocampal sclerosis. MRI after one month confirmed the diagnosis of PRES. The seizures recurred and the girl developed pharmacoresistant epilepsy and was admitted to our hospital for further investigation. Cerebral MRI three years after the diagnosis of PRES showed hippocampal sclerosis which was not present on the initial MRI. We conclude that there is a triggering role of PRES in the development of hippocampal sclerosis. Hippocampal sclerosis may have resulted from seizure-associated damage, alternatively, hypertensive encephalopathy may have led to hippocampal damage via a vascular mechanism