Psychosurgery: some current observations.

The term "psychosurgery" encompasses a wide variety of different neurosurgical procedures applied in the treatment of behavioral and psychiatric disorders. Arguments about the effectiveness and ethicality of psychosurgery are often based on studies using outdated procedures or inappropriate patient populations. The debate over psychosurgery is also obscured by the frequent confusion between its use in classical psychiatric syndromes and in such controversial areas as aggression or violent behavior associated with temporal lobe epilepsy. The author believes that such factors need to be clarified so that practitioners can choose a personal position based on sound medical fact.     

The determinants of arithmetic skills in young children: some observations

The cause or causes of arithmetic difficulties in young children are manifold. The condition has its origins in a set of complex disorders and may be due to genetic factors, developmental delays, experiential limitations, language problems, and perceptual, motor, memory and other cognitive weaknesses. Other factors which may cause the disorder are inappropriate and ineffectual instructional practices. Anxiety and unfavourable attitudes towards the subject may influence mastery of arithmetic attainment in young children.     

Pleomorphic xanthoastrocytoma: some new observations.

Fourteen cases of pleomorphic xanthoastrocytoma (PXA) occurring in Japan were investigated to evaluate its various pathological features. The patients were generally young (average: 19 years), the tumor was superficially located and CT revealed well circumscribed contrast enhancing mass which was often accompanied by a cyst. Histopathological study revealed that the PXA is a pleomorphic and frequently desmoplastic astrocytic tumor characterized by chronic degenerative changes including lipidization of tumor cells. The desmoplasia was assumed to secondary proliferation of meningeal fibroblasts. Although the general consensus is that pial astrocytes are the most likely origin of PXA, "ordinary" astrocytoma may well develop into PXA by invading overlying meninges and inducing desmoplasia.     

The future of child neurology: a profile of child neurology residents

Current workforce projections estimate that there is a shortage of child neurologists. We surveyed child neurology residents to learn more about the entry point for a career in child neurology: what attracts current residents to the field of child neurology and what the future career plans of child neurology residents are. Most respondents (52%) were exposed to child neurology for the first time in their third or fourth year of medical school, with 41% reporting that they chose the specialty at that time. US medical graduates identified having a mentor as one of the most influential exposures in their career choice. Respondents predict that they will spend less time on patient care and more time on research than current practicing child neurologists report. When asked about what could improve the attractiveness of the field, residents responded that medical students should get increased and earlier exposure to child neurology. Given the declining number of individuals pursuing a career in child neurology and that current residents predict that they will spend less time seeing patients than their predecessors do, understanding how to attract more candidates to child neurology will be essential to alleviate future shortages in child neurology.     

Personality change after stroke: some preliminary observations

OBJECTIVES: To describe changes in personality after stroke and effects on carers. METHODS: A consecutive series of patients was recruited from hospital admissions with stroke. A novel questionnaire was administered to the patients' main carer at nine months after the stroke to determine their perception of the patients' pre-stroke and post-stroke personality. Personality change was identified by changes in these ratings, and associations between personality change and the following variables explored: emotional disorder in patients and carers (measured using the hospital anxiety and depression scale and a structured psychiatric interview), stroke classification (Oxford community stroke classification), residual disability (Barthel index and Nottingham extended activities of daily living scale), and lesion characteristics on computed tomography (CT). RESULTS: Carers of 35 patients with stroke took part. Reported changes in personality after stroke included: reduced patience and increased frustration (both p<0.0001, t test of difference), reduced confidence, more dissatisfaction, and a less easy going nature (all p<0.005). Occasionally, aspects of personality change were seen as positive by carers. There were relations between greater personality change and interviewer rated patient depression or anxiety (p<0.001) but not when this was self rated; and between personality change and both emotional disorder in carers (p<0.005) and greater disability (p<0.01) but not CT lesion characteristics. CONCLUSIONS: Carers commonly perceive personality change in stroke patients. This is associated with self rated emotional distress in the carer. More research is needed to understand what carers mean by "personality change" and what factors contribute to the perceived change.     

Six-week trial with diazepam: some clinical observations

Side effects, improvement, and predictors of response were examined in 295 patients treated for greater than or equal to 1 week with diazepam; 234 of these patients completed 6 weeks of treatment. The greatest improvement occurred during the first week of treatment. Sedation was the predominant side effect. Predictors of improvement included low educational level, lack of previous treatment, presence of precipitating stress, low occupational and/or family adjustment, low levels of trait anxiety, and high levels of state anxiety.     

The neurology of decreased activity: abulia

Delirium is sometimes defined as acute onset of either overactivity or underactivity. This article reviews the nature and clinico-anatomical locations of lesions in patients with reduced activity. The term abulia is used to describe global underactivity. Abulia is customarily explained by interruptions in frontal-subcortical circuitry. These interruptions can occur with lesions in the frontal lobes, caudate nuclei, midbrain, and thalamus. The article describes the anatomy of frontal and subcortical circuits and reviews in detail individual cases and series of patients with reduced initiative and activity who have had localized central nervous system lesions.