Hemispherectomy, or hemidecorticectomy as it is more accurately described, has been highly effective in reducing or eliminating medically intractable seizures associated with hemiplegia. Because of late onset postoperative superficial cerebral hemosiderosis and its associated neurologic deterioration, this procedure was all but abandoned for years. With improved surgical techniques and diagnostic ...

The treatment of epilepsy depends on an accurate diagnosis of the specific type of epilepsy. Where possible it is important to prescribe the minimum amount of medication for seizure control, preferably with monotherapy. The ultimate aim of treatment is to achieve maximal improvement in the quality of life for the ...

We observed unilateral dystonic posturing of an arm or leg in 41 complex partial seizures (CPS) from 18 patients. In all cases this was contralateral to the ictal discharge. Unilateral automatisms occurred in 39 of 41 seizures on the side opposite the dystonic limb. Version occurred in 11 of the ...

This study investigated the usefulness of aversive conditioning of a mild punishment procedure that had ceased to suppress target behaviors to clinically acceptable levels. A 6.8-year-old severely retarded boy with high levels of aggressive, destructive, and loud screeching behaviors was readmitted to a psychiatric facility to adjust behavioral programs and ...

What is the nature of the kindling process? We hypothesize that kindling is a discontinuous process involving discrete, stepwise transitions from one state of neural organization to another. Our data from the kindling antagonism paradigm argue that there are two critical transitions in the kindling process. These transitions constitute major ...

Physicians who treat patients with allergic rhinitis have a number of therapeutic options, including antihistamines, decongestants, cromolyn, anticholinergics, corticosteroids, and immunotherapy. Antihistamines are widely used for the treatment of mild allergic rhinitis and are often effective, although more severe cases will require other medications. The newer antihistamines may induce less ...

Children with seizure disorders frequently are treated with anticonvulsant medications such as clonazepam, valproic acid, carbamazepine, and ethosuximide, which cannot be given parenterally. When the child is unable to take these anticonvulsants orally, he or she may be given parenteral doses of phenobarbital or phenytoin. In many cases, these two ...

Observer variability in interpreting medical tests and in making diagnoses influences both clinical practice and research. Uniform classification of epileptic seizures is especially difficult. Although the ILAE classification scheme for seizures has been available for many years, the reliability of this system has not been previously assessed. Verbatim descriptions of ...

Secondary mania may be caused by metabolic derangements, intoxications, and/or structural lesions, as well as by epilepsy. The authors describe a maniclike illness in a 16-year-old girl in whom a right frontal arteriovenous malformation was discovered. The most effective medical therapy was a combination of lithium and carbamazepine. Ultimately, the ...

Clinical seizures ceased during six months of clomiphene citrate therapy in a 36-year-old man who had hypogonadotropic hypogonadism, reproductive dysfunction, and a 16-year history of regular seizures. Seizures recurred during the month that followed the discontinuation of clomiphene therapy. This apparent antiseizure effect of clomiphene is discussed in terms of ...

Fourteen patients with secondary generalized epilepsy suffering from multiform seizures (MS) not amenable to medication were submitted to partial section of the corpus callosum. In all patients, there was a partial disruption of the previous generalized bilateral synchronous epileptiform discharges (GBSD). The electroencephalographic findings after callosal section are discussed with ...

In this article, the range of medical and other specialized services for epilepsy are reviewed. The objectives are outlined and the present shortcomings are highlighted. Suggestions are made for improvements and in particular we draw attention to the need and place for the development of epilepsy clinics for patients whose ...

The effects of fenfluramine on 21 maladaptive behaviors in 20 autistic individuals were examined over a 9-month period utilizing a double-blind, cross-over, placebo-controlled design. Raters carried out time-sampled observations in the school and residence. In addition, videotaped data were collected in controlled settings and assessed by the raters at the ...

Progressive external inflammatory root resorption, a result of persistent inflammation within the periodontal membrane, will cause eventual destruction of the tooth root if the inflammation is not eradicated. This study examined the effects of an antibiotic/corticosteroid paste on experimental inflammatory resorption induced in monkeys in vivo. Histologic evaluation of results ...

The authors present three case reports illustrating that a conservative approach to anorgasmia induced by effective treatment with the monoamine oxidase inhibitor (MAOI) phenelzine can result in spontaneous remission. Precipitously stopping phenelzine or adding another medication to counteract the side effect can be avoided. The apparent synchrony between the development ...

Seizures remain among the most serious side effects of psychotropic drugs. The authors review the literature associating neuroleptic and antidepressant medications with seizures, discussing the relative "seizurogenicity" of different medications, risk factors for seizures, and drugs of choice for high-risk patients. Case histories are presented. Available evidence suggests that molindone, ...

The majority of patients with epilepsy have their first seizure during childhood and are first evaluated and diagnosed by their pediatrician. For many patients the medication selected by the pediatrician will be taken for an extended time period, perhaps even for a lifetime. The first job of the pediatrician is ...

Recent community- and hospital-based studies of epilepsy from its onset suggest a much better prognosis than previously recognized, with about three-quarters of patients entering long-term remission on current medication. The first two years of medication are crucial in determining longer-term prognosis. Early effective therapy may be important in preventing the ...

The present report evaluates the suppression of antiepileptic drugs in a group of 608 epileptics. Conditions for the suppression of antiepileptic treatment included a previous seizure-free period of 5 years under medication, and a careful evaluation of individual social and work-related circumstances. The reduction of medication was realized during a ...

The authors measured knowledge about medication and its side effects, impact of side effects, and compliance in 30 chronic outpatients before and after they participated in two instruction sessions about their medication held one month apart. Instruction consisted of a verbal or a written and verbal presentation and minimum or ...

Intravascular contrast media are important in the radiological diagnostic process. Their use is associated with significant side-effects, but new low-osmolar contrast agents have been developed in an attempt to decrease the severity and incidence of these. The molecular structure of contrast media and their relationship to side-effects is discussed. The ...

Dimethylaminoethylphosphonate (DMAEP) was incorporated into the phospholipids of the ciliate protozoan Tetrahymena thermophila at the expense of both phosphatidylethanolamine and phosphatidylcholine, but it had no effect on the levels of the 2-aminoethylphosphonolipid. The newly formed DMAEP-lipid accounted for almost 50% of the phospholipids of the organism. The DMAEP was incorporated ...

The effect of EHDP medication was studied in 25 patients in whom heterotopic ossifications around the hip (19 cases) and elsewhere were resected. EHDP seemed to have a favorable effect on prevention of reossification and on function, particularly when ectopic ossifications were resected after total hip replacement. In all the ...

The potential loss of driving privileges is a major concern of patients with epilepsy and other episodic brain illness. The extreme variation from state to state in reporting requirements and the duration of restrictions illustrate the legal ramifications of uncertain medical advice. We studied the reliability of various methods of ...

An 18-year old man had a cluster of three seizures in a few hours and then remained seizure-free without medication; his mother has experienced seizures induced by movement. A 29-year-old man has had recurrent seizures for six years. In both cases, seizures were partial motor seizures induced by chewing. They ...

The value of the EEG in the decision to terminate antiepileptic treatment has been investigated on the basis of longitudinal EEG studies in 433 children and adolescents with epileptic seizure disorders. The data were subjected to uni- and multivariate statistical analysis. Most valuable information concerning the risk of seizure recurrence ...

Each of three catecholamine agonist medications (clonidine, L-dopa, and ephedrine) and placebo were administered for 2-week trials to a group of amnesics with Korsakoff's psychosis following a double-blind, counterbalanced design. During the last 3 days of each treatment, patients were given a battery of neuropsychological tests to determine the effects ...

Although epilepsy remains an unsolved medical problem, there is a type of epilepsy known as 'photosensitive epilepsy' described in the medical literature that could serve as the window to understanding the pathophysiology of all epilepsies. Photosensitive epilepsy is a seizure phenomenon caused by exposure to bright and/or flickering light. This ...

One hundred forty-four scalp ictal EEGs from 54 patients were analyzed independently by three electroencephalographers for side and lobe of seizure onset. Observers did not know the patients' identities. Accuracy was determined by depth EEG. We found 58 to 60% agreement between observers for lobe, and 64 to 74% for ...

Four hundred patients (221 young, 179 adults) with a cerebral concussion (317 minor, 83 mild) were examined within 48 hours after blunt head injury. In mild concussions there is a threefold homogeneous increase in the different EEG and BEP abnormalities compared to minor concussions. In the younger group EEG abnormalities ...

Recent evidence from experiments in animals suggests a rationale for more effective pharmacologic and physical therapy in patients with vertigo. In particular, one must consider the possible effects of medications on the adaptive processes that naturally mediate recovery from vestibular lesions. The challenge now is for clinicians to devise medication ...

Sudden unexpected deaths in epileptic persons are not rare events, most commonly encountered by the forensic pathologist rather than the clinician. Such deaths may represent 1-1.5% of all "natural" deaths certified by the medical examiner or coroner. The typical victim is a black male about 30 years of age who ...

Transdermal scopolamine medication has been evaluated in 30 cases of acute peripheral vertigo. The double blind study revealed favourable effects, e.g. in Menière's disease. The best compromise between effect and side-effects was one active medication patch. The side-effects were those described for scopolamine, such as blurred vision and dryness of ...

The effects of the H I receptor antagonists astemizole and chlorpheniramine on dermographism were compared in a double-blind study in sixteen patients. Both drugs resulted in a parallel and significant depression of the dermographic force-response curve and an elevation of the weal-force threshold, but the changes were greater in the ...

Verapamil, a calcium antagonist, is effective in delaying death in mice after i.v. challenge with sea nettle (Chrysaora quinquecirrha) or Portuguese man-o'war (Physalia physalis) crude venom. Death caused by these venoms could also be delayed by prior medication of the animals. Continuous EKG monitoring of sea nettle venom-challenged rats demonstrated ...

Elements relevant to differential diagnosis between epileptic seizure and non-epileptic seizure as a consequence of syncope, cardiac arrhythmia or pseudoepilepsy are reviewed and discussed. Our experience with long-term monitoring of closed circuit TV-EEG of 136 medically refractory seizure patients showed that (a) about 19% have pseudoepileptic seizures, (b) only 36% ...

A simple and effective method of temporary tarsorrhaphy, which is referred to as intermarginal serpentine temporary tarsorrhaphy, is presented. The tarsorrhaphy is created by passing a 6-0 Prolene suture in a serpentine manner across the eyelids, entering and exiting from the eyelid margin. This type of tarsorrhaphy is easy to ...

The concept of psychogenic epilepsy was recently revived by Sartre (L'Idiot de la Famille, 1971-2) in relation to Gustave Flaubert's epilepsy, which he believed was secondary to hysterical neurosis and not due to a cerebral lesion. A detailed clinical description of Gustave Flaubert's personal and medical history from birth to ...

Thresholds to noxious heat stimulation were increased following microinjection of zimelidine, an inhibitor of 5-hydroxytryptamine (5-HT) re-uptake, into the nucleus raphe magnus (NRM) of rats. Pretreatment with intraperitoneally given cinanserin reduced this effect but pretreatment with intraperitoneally given phenoxybenzamine did not. Fenfluramine, which causes the release of 5-HT from synaptic ...

Primidone has been reported to be effective in reducing tremor in patients with benign essential tremor. There is at least one report that suggests that the medication may reduce voice tremor, a frequent component of the essential tremor syndrome. Three patients with spastic dysphonia of essential (voice) tremor and one ...

Expected drug effects may be enhanced or lessened in a pregnant woman, and the known side effects may become more likely. Possibly devastating effects on the fetus must be considered. In the care of a pregnant patient and her unborn, medications should be used only when absolutely necessary (Figure 2). ...

Metrizamide, a nonionic, water-soluble contrast medium, has been increasingly used for myelography. We saw a patient with cortical blindness, seizure, organic psychosis, and asterixis after undergoing attempted metrizamide myelography via C1-2 puncture. Computed tomography demonstrated early penetrance of metrizamide into the brain parenchyma, most prominently in the occipital lobes. A ...

The pediatrician has a central role in the diagnosis and treatment of children with epilepsy. Accurate classification of the seizure type according to the international terminology is an important step toward the selection of the most effective antiepileptic medication. Technologic advances such as CT scan, video-EEG monitoring, prolonged ambulatory EEG ...

The long-term effect of anticholinergic medication in female patients with overactive detrusor function was studied in a group of 73 patients. The definition of overactive detrusor function is in accordance with the terminology and definition of the International Continence Society. The patients were mailed a questionnaire about the medication, its ...

We describe the clinical features of a family with photosensitive epilepsy, followed for 13 years. Generalized paroxysmal discharges induced by photic stimulation appeared in all 9 siblings. Generalized seizures, myoclonic jerks, and absences appeared in variable combination in 7 of them who on clonazepam remained free from seizures for a ...

Four of the most commonly reported side effects of dextroamphetamine ( Dexedrine ) and methylphenidate (Ritalin), viz., anorexia, insomnia, stomach pains, and weight loss, were reviewed, with special attention to growth suppression accompanying weight loss. The available evidence indicates that the effects of insomnia, anorexia, and stomach pains are transient ...

A girl, born in 1975, developed severe aplastic anemia in November 1982 while on ethosuximide monotherapy for petit mal epilepsy, about 3 months after starting the ethosuximide medication. She was treated with bolus-methylprednisolone as described by Bacigalupo et al. (13), transfusions and antibiotics. During the third week on this regimen ...

Maprotiline is a tetracyclic antidepressant which appears to have accounted for a relatively large proportion of the seizures associated with antidepressant use. The literature proposes two mechanisms of seizure induction: interaction with other medications and concomitant medical conditions lowering the seizure threshold. Observations during a study of maprotiline blood levels ...

Usage of the terms placebo and placebo effect has changed dramatically within medical history. Although placebos are still useful within research, the placebo effect has become a large and ill-defined concept threatening to obscure rather than to clarify whatever phenomenon is being described. Placebos and placebo effects should be fundamentally ...

Medication use is commonly measured in clinical pain control studies. Equivalence to a standard medication (e.g., morphine), effective dosage, and percent changes from before to after treatment have been used to provide quantitative medication intake measures which are amenable to statistical analysis. Problems with these methods arise when specific medications ...