Early prognosis of epilepsy. Effects of treatment in the first follow-up year

A multicenter prospective investigation was conducted in 17 teaching and general hospital in Italy to assess the efficacy of the care delivered to previously untreated patients with epilepsy. 175 cases were included and allocated to monotherapy. Only 112 cases completed the first year of follow-up. Of these, 59 (52.7%) were completely controlled and 53 (47.3%) had one or more seizure relapses. Controlied and uncontrolled patients were compared with respect to the main variables believed to influence non-responsiveness to standard therapy. The proportion of cases with relapses was significantly associated with the number of seizures reported before treatment was started. Selected seizure patterns (absences, myoclonic seizures) and prolonged disease duration were also reported more frequently among patients with recurrences. The implications of these findings are discussed with respect to drug response and prognosis of epilepsy.

---

Sommario Il presente studio consiste in una indagine prospettica multicentrica condotta in 17 centri ospedalieri italiani sulla efficacia del trattamento e sulla prognosi della malattia in pazienti con epilessia alla prima diagnosi. Dei 175 casi ammessi allo studio, 112 hanno completato il primo anno di osservazione. Di questi, 59 (52,7%) risultavano completamente controllati e 53 (47,3%) avevano presentato una o più crisi durante il follow-up. Le principali variabili ritenute responsabili di una insoddisfacente risposta al trattamento vennero quindi esaminate nei due gruppi. Il rischio di recidiva di crisi risultava significativamente correlato al numero di crisi presentate prima del trattamento. Inoltre, i pazienti con crisi nel follow-up presentavano una maggior durata di malattia o specifici tipi di crisi (assenze, crisi miocloniche). Il significato di tali dati è discusso in riferimento alle modalità di trattamento e agli altri fattori implicati nella prognosi dell'epilessia.

     

Impromptu micturitional flow parameters in normal boys

Nonintrusive measurement of the hydrodynamic properties of the urinary stream (uroflowmetry) has been included in many adult urological evaluations as an objective diagnostic tool. Measurement and behavioral problems interfere with practical applications in children. We describe a standard procedure for obtaining "impromptu" micturitional flow parameters in clinical pediatric practice. Statistical correlations of these flow parameters in an unselected group of 142 normal boys between 2 and 12 years old are presented. Useful linear regression equations were derived from the sample to assist the clinician in predicting deviations from normal values. Limitations of the methodology are noted.     

Endogenous dopamine release from tuberoinfundibular neurons: Does calmodulin play any role?

Summary The possible involvement of calmodulin in the process of endogenous dopamine (DA) release from arcuateperiventricular nuclei-median eminence fragments, containing tuberoinfundibular dopaminergic (TIDA) neurons, has been investigated in an in vitro incubation system. For this purpose the basal and K⁺-stimulated DA release was examined in the presence and in the absence of the different putative calmodulin antagonists, pimozide, trifluoperazine, penfluridol and N-(6-aminohexyl)-5-chloro-1-naphthalene-sulfonamide (W-7).Trifluoperazine and pimozide in concentrations up to 100 M were both uneffective in blocking K⁺-evoked DA release. Penfluridol in doses of 5 and 10 M, did not prevent 35 mM K⁺-induced endogenous DA release. It was able to reduce K⁺-stimulated DA release only at the very large concentration of 100 M.W-7 added in vitro to the hypothalamic fragments, prevented endogenous DA release evoked by 35 mM K⁺ in a dose-dependent manner. W-5, a chlorine deficient analogue of W-7, that interacts only weakly with calmodulin, failed to modify K⁺-stimulated endogenous DA release in doses up to 200 M.All the putative calmodulin antagonists used in the present study did not induce any change of basal DA release.IN conclusion the fact that most of the agents, except W-7, known to antagonize calmodulin-dependent processes in many biological systems failed to interfere with the release of endogenous DA from TIDA neurons seems to suggest that calmodulin does not play a crucial role in the process of DA release and that the inhibitory effect of W-7 on endogenous DA release may be better attributed to other mechanisms different from its anticalmodulin action.     

乙酰肉碱及肉碱对实验性心力衰竭的影响

Acart和cart对犬或兔由戊巴比妥所致的急性衰竭心脏均有明显的正性变力,血管扩张和负性变速作用。在心衰犬,静注acart或cart后,再给stro-k均可使其诱发心律失常及致死量明显提高(p<0.05),安全范围增大。当acart或cart与stro-k以较小剂量合用于心衰兔时,二者产生协同强心作用。而且,acart不论单用,或与stro-k合用,其强心作用均比cart强。     

Caffeine actions on currents induced by calcium-overload in Purkinje fibers

The ionic events underlying the changes induced by caffeine in calcium-overloaded Purkinje fibers were studied by means of a voltage-clamp technique. The following results were obtained. In fibers exposed to strophanthidin (5 X 10(-7) M), a depolarizing clamp of suitable magnitude or duration is followed by an oscillatory current (Ios) often superimposed on a decaying inward tail current (the "tail current"). Caffeine (9 mM) abolishes Ios and increases the tail current. Caffeine has similar actions when calcium overload is induced by increasing [Ca]0 or decreasing [Na]0. The magnitude of the tail current is reduced by decreasing [Ca]0. The tail current appears with repolarizations to -40 mV or more negative values as Ios appears in the absence of caffeine. As with Ios the tail current can be triggered twice (during and after a test clamp of suitable characteristics), becomes more inward with repeated clamps and becomes larger with larger or longer conditioning clamps. During the recovery from caffeine exposure, the tail current decreases gradually as Ios returns progressively. It is concluded that both Ios and tail current are caused by calcium overload but are affected in opposite direction by caffeine, apparently because caffeine decreases the calcium overload in the sarcoplasmic reticulum (abolition of Ios) and increases the calcium to be extruded from the sarcoplasm (increase in the tail current).     

Electromyography and nerve conduction study in autosomal dominant olivopontocerebellar atrophy

Summary Electromyographic examination and studies of motor and sensory conduction velocities were performed in 11 patients with a presumptive diagnosis of olivopontocerebellar atrophy with autosomal dominant transmission. Peripheral nervous system involvement was shown in eight. In two patients with early onset of disease, electrophysiological alterations clearly pointed to severe axonal degeneration, whereas in six they were compatible with slight demyelination.

---

Zusammenfassung Bei elf Patienten, bei welchen eine olivopontocerebelläre Atrophie mit autosomal dominanter Übertragung angenommen wurde, führten wir eine elektromyographische Untersuchung und eine Bestimmung der motorischen und sensiblen Erregungsleitungsgeschwindigkeit durch. Bei acht dieser Patienten wurde eine Mitbeteiligung des peripheren Nervensystems nachgewiesen. In zwei Fällen mit frühem Krankheitsbeginn wiesen die elektrophysiologischen Veränderungen eindeutig auf eine schwere axonale Degeneration hin, während bei sechs die Befunde mit einer leichten Demyelinisation vereinbar waren.

     

Factor analysis in gated cardiac studies

Factor analysis of dynamic structures (FADS) can automatically provide "physiological" factors related to anatomical structures that have different temporal behavior, even if these structures overlap; it also yields images corresponding to the factors' spatial distributions. In normal patients, two significant cardiac factors, corresponding to the atria and the ventricles, may be extracted. A third significant factor can be obtained when additional dynamic structures exist. However, the method does not provide an estimate of the background. It becomes part of the factors, but it does not modify their shapes. FADS has been applied to 45 gated cardiac studies. Results obtained by FADS were compared with those obtained from the amplitude and the phase of first-harmonic Fourier analysis (FA). The joint results were compared with the final diagnosis, established by real-time echocardiography and/or ventriculography. In normal patients, good agreement was obtained between the two approaches. On the whole set of patients, FADS was significantly better than FA (by sign test: p less than 5%).     

Drop attack as the only symptom of type 1 Chiari malformation. Illustration by a case

An unusual case of Chiari type I malformation is presented. The only symptom was a "drop attack" during sneezing or coughing. The possible pathogenetic mechanisms are briefly reviewed and the good results of the surgical therapy are stressed.     

Heparin inhibition of polymorphonuclear leukocyte activation in vitro. A possible pharmacological approach to granulocyte-mediated vascular damage

The "in vitro" effects of heparin on different functions of human polymorphonuclear leukocytes were studied. Granulocyte aggregation, enzyme release induced by FMLP and zymosan-activated serum and superoxide anion and chemiluminescence generated by FMLP were assessed. Heparin (25-500 micrograms/ml) was able to inhibit in a dose-dependent way cellular aggregation and degranulation induced either by FMLP or by zymosan-activated serum. FMLP-dependent superoxide anion generation and chemiluminescence were specifically inhibited by heparin at the concentration of 25 micrograms/ml. Our results showed that heparin "in vitro" inhibits all the aspects of the functional and metabolic granulocyte activation. A possible protecting effect of the drug on leukocyte-mediated tissue injury and vascular damage is discussed.