摘要:

A total of 27 patients with medically intractable complex partial seizures has been investigated for effects of anticonvulsant drugs on mental abilities, particularly on verbal memory performance. Fourteen patients with right (RTLE) and 13 with left (LTLE) temporal lobe epilepsy have been tested with a word list learning paradigm under the conditions of full and reduced anticonvulsant medication. Memory performance has significantly improved with drug reduction, however only for the LTLE group. In addition, significant group differences for verbal memory between LTLE and RTLE subjects under full medication have completely disappeared with drug reduction. Finally this investigation demonstrates, that very specific and circumscribed steps of verbal memory processing, particularly retrieval abilities after interference, are affected by anticonvulsants. These findings underline the importance of pharmacological effects on cognition and suggest to reevaluate their relevance compared to other contributing factors.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04066.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Parkinsonism death rates in Italy were analysed for the period 1969–1987. Crude death rates increased markedly in the above period for both sexes. Age‐specific rates underwent important changes during these twenty years. In the years 1969‐71 the age‐specific death rates reach their maximum values at ages 80‐84, after which they decline. In the years 1983‐87 the rates continue to increase until the 80‐84 age group, when they reach a plateau. Moreover, in the more recent years the age‐specific rates for ages<70‐75 are lower, whereas those for the older ages are approximately twice as high as the values in the earlier years. The age‐adjusted death rates (1981 Italian population) increased slightly in the period studied for both sexes. Rates for males exceed those for females in all the previous analyses. Minor differences appeared in death distribution between the five large areas Italy was divided into. The observed changes in death rates are likely to reflect: changes in age composition of the population over time, greater attention to parkinsonian patients and especially increased duration of this disease following the discovery of its neurochemical basis and effectiv

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04067.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A series of 31 Parkinson's disease (PD) patients suffering from panic attacks (PA), late in the evolution of their disease, was analyzed from a group of 131 levodopa‐treated PD patients. We found that many of motor, sensory, and vegetative symptoms, previously described as complicating phenomena in PD, constituted some of the symptoms of panic disorders. Comparing PA series with the series of PD patients who did not complain of PA, we discovered a clear‐cut relationship of PA with the presence of standing/gait troubles (p<0.001), depression (p<0.001), and dyskinesias/fluctuations (p<0.001). The patients of the PA series also presented a more precocious age of PD onset, were put on levodopa therapy earlier, and needed to be treated with higher doses of levodopa than the patients without PA. Finally, we hypothesize that PA could be considered to be a sort of abstinence syndrome from levodopa, because they appears mostly (90.3%) in the OFF phase of fluctuations, and are relieved administering new doses of levodopa or dopaminergic agonists. Nevertheless, we suggest PA are not directly related to the pharmacological properties of levodopa, but to alterations of the noradrenergic systems in the

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04068.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Using Ellman spectrophotometric method we measured the total cholinesterase (ChE) activity in lumbar cerebrospinal fluid (CSF) of 13 persons without neurological disorder, 10 non‐demented patients with cerebral infarcts, 17 patients with dementia of Alzheimer's type (DAT) (11 presenile, 6 senile cases), 10 patients with multi‐infarct dementia (MID), 1 patient with Parkinson's disease associated with dementia. The ChE activity in CSF was significantly lower in the DAT group compared with age‐matched control subjects (p<0.001). This paper also analyses the possibility of using CSF ChE activity as a marker of DAT, and the relationships between its level of activity and the age of the patient at onset, stage of illness and severity of dementia as well as discrepancies in the data published so far. Previous work has shown that ChE activity in the brain tissue and CSF of MID is normal: therefore, if low ChE activity is found in the CSF of MID patients, as was obtained in 8 out of 10 cases in our series, the diagnosis of mixed dementia should be consi

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04069.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A retrospective review is presented of neurologic complications in our first 143 consecutive adult patients (208 liver transplants in 143 adults and 18 children) undergoing liver transplantation. Nineteen (13.2%) of the 143 patients developed neurologic complications in the postoperative period. Immunosuppression was initiated intraoperatively with steroids with the addition of azathioprine on Day 1 and cyclosporine, adjusted by RIA to a level of 400‐600 ng/ml, on Day 2 post‐transplantation. Azathioprine is discontinued in the third month. Fourteen of the 19 patients (73.6%) presented with CNS complications characterized by: diffuse multifactorial encephalopathy (5 patients); leukoencephalopathy (2 patients) which required temporary (1 case) or permanent (1 case) discontinuation of cyclosporine A; hemorrhage (in 2 cases due to arterial hypertension and coagulopathy and another due to unknown causes); ischemic/anoxic injury secondary to cardiorespiratory arrest (2 patients) or arteriothrombosis (1 patient); and myelopathy (1 patient) due to vertebral compression (T10‐T11) secondary to osteoporosis. The diagnostic studies most often employed were computed tomographic (CT) (85.7%) and electroencephalography (EEG) (42.8%). Five of 19 patients (26.3%) suffered peripheral nervous system (PNS) complications: 1 patient with reversible Claude‐Bernard‐Horner Syndrome caused by central venous catheterization during anesthesia: 2 patients with peroneal nerve palsy due to compression below the knees by operating room table supports; 1 patient with an irreversible lesion of the right recurrent laryngeal nerve secondary to prolonged intubation and central venous catheterization; and 1 patient with a reversible lesion of the left brachial plexus secondary to inadvertant hyperextension of the upper extremity on the O.R. table due to the need for dialysis and catheterization of the axillary vein for veno‐venous bypass. Nine of fourteen (9/14, 64.2%) of patients with CNS lesion died. In five of the nine patients (55.5%) who died with CNS lesion, the neurologic lesions (CNS hemorrhage and anoxic‐isquemic injury) were directly or indirectly responsable for death. Strict control of patient positioning in the operating room, arterial hypertension and coagulation disturbance in the immediate postoperative period and serum cyclosporine A levels would eliminate the majority of neurologic complications in patients undergoing liver tr

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04070.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Mitochondrial DNA (mtDNA) deletions have been noted in small quantities in a handful of atypical cases of myotonic dystrophy and there are clinical and pathological parallels between this autosomal dominant disease and certain mitochondrial myopathies where such deletions are well recognised. We studied 20 individuals from typical pedigrees of myotonic dystrophy (of whom 19 were clinically affected) with Southern blot analysis, and 2 of the affected individuals with PCR analysis of mtDNA, but were unable to demonstrate the previously noted deletions in any quantity by either method. We conclude that especially in view of known naturally occurring large scale and minor length variants in mtDNA, these previous findings are of dubious relevance to the disease.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04071.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A Swedish family with Paramyotonia congenita (Eulenburg) (PMC) is presented. Clinical neurological examination, neurophysiological examination (n = 5) and muscle biopsy (n = 4) were performed. Different clinical features were found in various combinations in the individual family members. The clinical symptoms were: (1) cold‐induced myotonia, (2) attacks of weakness, (3) persistent weakness and (4) no symptoms but other signs of muscle affection. In the patients with myotonia, the neurophysiological examination showed spontaneous myotonic discharges which were frequent at room temperature but disappeared after cooling. Furthermore, the amplitude of M. abductor digiti minimi compound action potential, during supramaximal ulnar nerve stimulation, decreased significantly after cooling. In the patients with persistent weakness there were no spontaneous myotonic discharges, but myopathic abnormalities were found in proximal muscle. In the patients with myotonia as well as in the patients with manifest muscle weakness, muscle biopsy showed a variation of muscle fibre diameters, centrally located nuclei, occasional atrophic fibers and an atrophy of type IIB muscle fibres. These findings are unspecific but have been described in PMC patients in earlier studies. An ancestor to the family, who had myotonia, lived in the same town and at the same time as Albert Eulenburg, which may suggest that this family is a part of the originally described family (1

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04072.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We tested the validity of a self‐administered version of the minimal record of disability (MRD) for multiple sclerosis (MS) by measuring the agreement level between patients' self‐assessment and neurologists' indipendent ratings. 96 MS patients and 4 neurologists took part in the experiment; the agreement level was measured in terms of the intraclass correlation coefficient (ICC). On the Kurtzke functional system (FS) the ICC ranged from 0.26 in the sensory to 0.69 in the pyramidal function; a high concordance (ICC = 0.84) was found on the expanded disability status scale (EDSS). The ICC values were above 0.70 for most of the incapacity status scale (ISS) and environmental status scale (ESS) items. A modified, self‐administered version of the MRD may represent a reliable instrument for obtaining a comprehensive profile of patients' abil

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04073.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

EEGs, brainstem auditory evoked potentials (BAEPs) and auditory event‐related potentials (ERPs) were recorded from 33 individuals infected with the human immunodeficiency virus, type 1 (HIV1 + patients: 13 CDC Class II or III; 20 Class IV). All were neurologically asymptomatic, non‐demented, and had a past history of intravenous drug abuse. Sixteen age‐ and sex‐matched normals and 10 HIV1 ‐ former drug addicts served as controls. Half of the HIV1 + and HIV1 ‐ subjects displayed mild EEG anomalies and, except for one HIV1 + patient, BAEPs were normal in both groups. ERPs were normal in all HIV1 ‐ subjects but anomalous (longer latencies of components P2, N2, P3; reduced amplitude of P3) in 9 HIV1 + patients (27%), the incidence of such anomalies being higher for Class IV than Class II/III patients. Auditory ERPs proved the most sensitive and specific of these electrophysiological procedures in detecting subclinical central nervous system involvement in H

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04074.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

In the present study the cognitive performance of 25 patients with Cushing's disease (CD) was extensively evaluated in comparison with normal control subjects, matched one by one. The results indicate a selective impairment of memory functions: the number of patients showing a significantly impaired mnesic performance increases with age. Moreover, the neuropsychological impairment tends to recover in those cases who underwent further controls after surgical treatment. The neuropsychological data are discussed in the light of recent evidence in the literature concerning the effects of adrenal steroids on the brain.

ISSN:0001-6314    

DOI:10.1111/j.1600-0404.1993.tb04075.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY