The crisis beyond the crises

This interview with Rafael M. Salas, executive director of the U.N. Fund for Population Activities, emphasizes that by the time the children of today have their own babies the population of the world will have at least doubled. This means not only twice as much food will be needed, but twice as much health care, twice as much in education, twice as many jobs. International assistance has never been more than a marginal addition to total nation resources. Even in India, which has long been a recipient of family planning aid, the total from outside sources is only 10%. In China one of the most extensive family planning programs in Asia receives no outside assistance. Donors must also reexamine their aid. Much has been wasted in countries which have no will to develop. Old systems which fail to move money and men into action need to be replaced with concrete plans and local experts must rapidly be trained to take the place of foreign experts. The oil shortage has demonstrated that the world is interrelated and that population and economics can no longer be separated. The shortage of oil has trebled phosphate prices, causing a shortage of fertilizer, and so on. Population and economics must become part of every country's development program; governments, private organizations, and concerned people must now do something about their children's world.     

Tardive oculogyric crises

Involuntary ocular deviations, or oculogyric crises (OGC), commonly occur in acute dystonic reactions to dopamine receptor blocking drugs (neuroleptics). We describe 4 patients with tardive OGC due to prolonged exposure to neuroleptics. In addition to the OGC, the patients had other tardive movement disorders. All patients improved with tetrabenazine. We conclude that tardive OGC are often not recognized and represent part of the spectrum of tardive dystonia.     

Efficacy of verapamil in mania crises

The authors review the different studies on the use of calcium antagonists in the treatment of acute mania. They present 7 cases, of which 4 with manic-depressive psychosis and 3 with schizo-affective disorder, during acute mania as defined by DSM III criteria, treated by verapamil at the dose of 320 mg/day. Four patients improved (2 manic-depressive, 2 schizo-affective), of which one that had responded neither to haloperidol nor to clonidine, and another for which all other treatment was contra-indicated due to important side effects. Three of these patients entered into acute depressive state between the 12th and the 15th day of treatment. The two most severe (manic-depressive) cases did not respond. The role of calcium in neuron physiology and the mode of action of calcium antagonists are outlined. The authors discuss the physiopathological hypothesis of Dubovsky.     

Partial benign crises in adolescence

The aim of this paper is to present the case of teenage patient with partial seizures fulfilling the criteria of benign partial seizures of adolescence. A 16-year-old male patient had two seizures with a sensory-motor "march" that evolved into a secondarily generalized tonic-clonic seizure on the same day. Several weeks before this event he had had several simple partial sensory seizures. The patient had no previous history of seizures and there was no family history of epilepsy. The neurological examination, EEG and magnetic resonance imaging were normal. The patient was treated with antiepileptic monotherapy during two years. The treatment was gradually tapered and withdrawn over the following six months. He has had no recurrences during the five years of follow-up. The early diagnosis of this entity has the significant prognostic and therapeutic repercussions.     

Multifocal epileptic crises following mumps

A 15 years-old girl with no previous history of epilepsy or neurological disease presented three types of epileptic symptoms the same day: 1) clusters of rhythmic myoclonus of the left hemiface; 2) episodes of painful paresthesias of the left arm followed by secondary generalised seizures; 3) episodes of elementary visual hallucinations of the right hemifield. She had several seizures each hour and some were recorded. There were no EEG abnormalities during the facial myoclonus but rapid rhythms were seen during the sensory and visual partial seizures on the right parietal and left occipital lobes. There was no fever and no drowsiness. The CSF tap showed pleocytosis. Serological studies indicated recent mumps. The drugs were initially inefficient. The seizures disappeared after a month. The drugs were stopped after three months and the seizures had not relapsed after a one year's follow-up. Though there were no other sign of encephalitis, we believe that episode of multifocal seizures was due to mumps encephalitis.     

A history of oculogyric crises during the encephalitis lethargica pandemic

A pandemic of what came to be known as encephalitis lethargica spread starting in the winter of 1916-1917 and continued into the 1930s. Neurological after-effects, namely permanent parkinsonian syndromes and various abnormal movements, permanently disabled the survivors of the one or two million victims, often children or young adults. Among them, a small proportion developed a symptom that was little known up to that point and that is currently exceptional: oculogyric crises; that is, a lateralised, dystonic upward movement of the eyes known as a tonic eye fit. This paper proposes a history of the recognition of this symptom, its inclusion in the neurological nosography, and the pathophysiological hypotheses postulated a century ago.