The link between alcoholism and affective disorders

The authors reviewed the family histories of 156 patients in an affective disorders program and identified two groups of affective disorders. Group 1 consisted of bipolar illness and major depression, with high familial incidence of affective disorder and low familial incidence of alcoholism. Group 2 consisted of dysthymic disorders and secondary depression, with low familial incidence of affective disorders and high familial incidence of alcoholism. These findings do not support the common assumption that primary affective disorders and alcoholism are closely linked. The authors discuss the implications for diagnosis of depression associated with alcoholism.     

A systematic review and meta-analysis on the epidemiology of Duchenne and Becker muscular dystrophy

The muscular dystrophies are a broad group of hereditary muscle diseases with variable severity. Population-based prevalence estimates have been reported but pooled estimates are not available. We performed a systematic review of worldwide population-based studies reporting muscular dystrophies prevalence and/or incidence using MEDLINE and EMBASE databases. The search strategy included key terms related to muscular dystrophies, incidence, prevalence and epidemiology. Two reviewers independently reviewed all abstracts, full text articles and abstracted data using standardized forms. Pooling of prevalence estimates was performed using random effect models. 1104 abstracts and 167 full text articles were reviewed. Thirty-one studies met all eligibility criteria and were included in the final analysis. The studies differed widely in their approaches to case ascertainment, resulting in significant methodological heterogeneity and varied data quality. The pooled prevalence of DMD and BMD was 4.78 (95% CI 1.94–11.81) and 1.53 (95% CI 0.26–8.94) per 100,000 males respectively. The incidence of DMD ranged from 10.71 to 27.78 per 100,000. This is the first meta-analysis of worldwide prevalence estimates for muscular dystrophies. There is a need for more epidemiological studies addressing global estimates on incidence and prevalence of muscular dystrophies, utilizing standardized diagnostic criteria as well as multiple sources of case ascertainment.     

Effect of clot removal and the different incidence of vasospasm between clipping and GDC

The removal of subarachnoid clot has been thought to be effective for prevention of cerebral vasospasm. However, it is suggested that the incidence of cerebral vasospasm is not high in the cases where ruptured cerebral aneurysms are obliterated using Guglielmi detachable coils (GDC) without clot removal. The effect of subarachnoid clot removal on the occurrence of cerebral vasospasm and the different incidence of cerebral vasospasm between clipping cases and in GDC cases are reviewed.Surgical clot removal in experimental model indicated marked preventive effect on cerebral vasospasm. However, the clinical trials of clot removal during early aneurysm surgery had failed to show satisfactory preventive effect for vasospasm, and the cumulative incidence of symptomatic vasospasm in these trials was 29%. As fibrinolytic drug, intrathecal administration of tissue plasminogen activator showed sufficient elimination of subarachnoid clot and prevention of cerebral vasospasm in the experimental studies and in the clinical case trials and nonrandomized case-control trials. However, the multi-center, randomized case-control trial showed no statistically significant effect on symptomatic cerebral vasospasm. On the other hand, the cumulative incidence of cerebral vasospasm in GDC cases was 20%. The comparative studies of the incidence of vasospasm between GDC cases and in clipping cases also showed less incidence of symptomatic vasospasm and a more favorable outcome in GDC cases. From the results of studies reviewed, the incidence of cerebral vasospasm seems less in GDC cases than in clipping cases. It should be clarified why clipping could not be dominant in the prevention of cerebral vasospasm compared to GDC.     

The vascular origins of the charles bonnet syndrome: Four cases and a review of the pathogenic mechanisms

The definitions of the Charles Bonnet syndrome are reviewed and four cases with the CT findings of three described. The incidence and the pathogenic mechanisms are discussed in the light of these cases, which suggest that disorders of the vertebrobasilar and posterior cerebral arteries underlie the syndrome.     

Incidence and prevalence studies in epilepsy and their methodological problems: a review.

Epidemiological studies in epilepsy have a number of specific problems, discussed here with reference to the published literature. Case ascertainment may pose difficulties because of deficiencies in patients reporting and in the diagnosis of seizures, and inherent methodological problems; the classification of epilepsy is often arbitrary and definitions variable; unsuspected selection bias may markedly influence incidence and prevalence rates. The major published incidence and prevalence studies are reviewed and the factors influencing these rates discussed.     

Stroke incidence and prevalence in Europe: a review of available data

Reliable data on stroke incidence and prevalence are essential for calculating the burden of stroke and the planning of prevention and treatment of stroke patients. In the current study we have reviewed the published data from EU countries, Iceland, Norway, and Switzerland, and provide WHO estimates for stroke incidence and prevalence in these countries. Studies on stroke epidemiology published in peer-reviewed journals during the past 10 years were identified using Medline/PubMed searches, and reviewed using the structure of WHO's stroke component of the WHO InfoBase. WHO estimates for stroke incidence and prevalence for each country were calculated from routine mortality statistics. Rates from studies that met the 'ideal' criteria were compared with WHO's estimates. Forty-four incidence studies and 12 prevalence studies were identified. There were several methodological differences that hampered comparisons of data. WHO stroke estimates were in good agreement with results from 'ideal' stroke population studies. According to the WHO estimates the number of stroke events in these selected countries is likely to increase from 1.1 million per year in 2000 to more than 1.5 million per year in 2025 solely because of the demographic changes. Until better and more stroke studies are available, the WHO stroke estimates may provide the best data for understanding the stroke burden in countries where no stroke data currently exists. A standardized protocol for stroke surveillance is recommended.     

The psychobiology of premenstrual dysphoria: review of theories and treatments

(1) Premenstrual mood changes such as depression, elation, anxiety, hostility and irritability are a common cause of disability in women. (2) The nature of the disorder, the clinical dimensions, the incidence, the psychological and psychosocial theories are reviewed. (3) A long list of treatments recommended over the years is also reviewed and discussed, illustrating the ambiguity and uncertainty in this area. (4) The relationship to other periodic functional conditions, especially manic-depressive illness is discussed with particular emphasis on predictive studies. (5) The psychoneuroendocrine mechanisms possibly involved in these premenstrual conditions are reexamined. A specific role for prolactin in the etiology of these premenstrual dysphoric states is suggested.     

Diagnosing high incidence autism spectrum disorders in adults

Autism spectrum disorders (ASDs), particularly the high incidence conditions of autism, PDD NOS, and Asperger's Syndrome, have become increasingly popular topics of study in the mental health field. Traditionally, the focus has been on young children and early recognition and diagnosis. However, given that these conditions are life long in nature, continued assessment in not only advisable but essential. This review covers diagnostic issues as they pertain to adults with high incidence ASD. The current state of nosology and diagnosis in adults with ASD is reviewed. A discussion of pragmatic diagnostic issues and future research needs are covered.     

Acute neurologic deterioration after surgical treatment for thoracic spinal stenosis.

Spondylotic changes in the thoracic spine resulting in a myelopathic syndrome is a rare condition. Surgical treatment consists of removal of the hypertrophied ligaments, facet joints and laminae (laminectomy). In this report, we review our experience in treating 12 cases of thoracic spinal stenosis (TSS). From 1989-1998, we identified 12 surgical cases treated by the Department of Neurosurgery at Temple University Hospital. For this report, we reviewed both inpatient and outpatient records and radiographic studies. We also reviewed the world's literature regarding this entity. After reviewing our own cases of TSS and the world's literature, we identified a higher than expected incidence of acute neurologic deterioration (AND) after surgical treatment of TSS (14.5%). This incidence is compared to an expected incidence of AND (0-5.5%) after laminectomy for cervical spinal stenosis (CSS). The seemingly higher incidence of AND after surgical treatment of TSS has implications for discussion of risks with patients undergoing surgical treatment.     

Lithium and cerebral functions

Two cases, sustaining the possible part of long term lithium therapy in progressive intellectual deterioration, are submitted. Arguments clinic as well as paraclinical and fundamental, supporting the idea of insidious lithium's neurotoxicity are discussed. Most recent findings about drug's incidence on the cerebral functioning are reviewed. The study of the erythroplasmatic ratio and the analysis of several factors implied in its variations seem to back up our hypothesis.     

Family breakdown and its effects on emotional disorders in children

The increase in the incidence of divorce and some of its causes are discussed. The literature relating to the effects of divorce on the emotional health of children is reviewed. It is suggested that the increase of divorce may account for the recent increase in certain emotional disorders in children. Various strategies to protect the children from the adverse effects of divorce are discussed.     

Epidemiology of Parkinson's disease and akinetic syndromes

New reports of the incidence, prevalence and mortality of Parkinson's disease and parkinsonism are reviewed. Evidence for occupational and lifestyle risk factors and protective factors is updated. Recent genetic epidemiology studies of parkinsonism in twins and families, and studies that investigated imaging and physiologic markers of dopaminergic function in members without parkinsonism are presented.     

Congenital epidermoid cysts over the anterior fontanelle

Epidermoid cysts over the anterior fontanelle were once regarded as rare and exclusive to blacks. The latest reports in the literature indicate a more widespread incidence. Only a few cases have been described in Europe. The authors report three cases of epidermoid cysts in this location occurring in Spaniards. Clinical, radiological, and surgical features are briefly discussed and pertinent literature is reviewed.     

An estimate of the incidence of depression in idiopathic Parkinson's disease.

Estimates of the prevalence of depression in idiopathic Parkinson's disease vary, but have been greater than in most comparison groups. In a survey of patients with Parkinson's disease (N = 339), the prevalence of depression was 47%. A total of 326 cases were reviewed to estimate the incidence of depression from September 30, 1984, to July 31, 1989. Assessments of depression during both the prevalent and the incident periods were noted in 258 cases. There was no history of depression in 129 cases, and nine new cases occurred. The incidence rate was 1.86% per year and the cumulative risk was 8.6%. Published estimates of the incidence of depression in the general population are few. In one study, the annual incidence of depression in individuals older than 40 years was 0.17%. In another, the incidence of depression in individuals older than 50 years was 0.14% for men and 0.29% for women. Although our retrospective study probably underdiagnoses depression, the incidence of depression is increased in Parkinson's disease.     

Stroke epidemiology in Europe

The information on epidemiology of stroke in Europe comes from mortality statistics and incidence studies. The purpose of this paper was to review the data on mortality, incidence, case fatality and stroke care in Europe, and to discuss geographical and temporal trends, taking into account methodological problems. The available updated studies on mortality and incidence were reviewed. Considering methodological characteristics, incidence studies were evaluated separately for “ideal” and “nonideal” studies. The preliminary data of the ongoing EC Stroke Project were also examined. Marked differences are observed in mortality rates across European countries. Rates are higher in Eastern compared to Western countries. Temporal trends are decreasing in Western and increasing in Eastern countries. Incidence data are scanty and probably not fully representative. Preliminary observations show that marked differences exist in stroke care across different countries. Geographical and temporal trends in mortality and morbidity may reflect both methodological inhomogeneity and differences in prevalence of risk factors, incidence and survival. Differences in socio-economical level may have an impact on stroke care, and may indirectly influence stroke frequency measures. A collaborative effort is needed for standardizing the methodologies, checking the reliability of data, and examining more extensively trends in risk factors and stroke care. This may make it possible to optimize the cost effectiveness of management of stroke patients in Europe.     

Cerebrovascular diseases: a review of the Indian experience in the last 35 years

The relevant literature on cerebrovascular diseases from the Indian subcontinent in the last 35 years has been reviewed. Most of the data available are from retrospective studies carried out in various large urban hospitals. The incidence of stroke reported is less when compared with western figures, which may be a reflection of the population at risk. The incidence of stroke in the young Indians below the age of 40 years is higher compared to other countries, which again may be a statistical aberration or may be due to local aetiological factors. Ischaemic cerebrovascular complications of pregnancy and puerperium occur frequently, but the total picture is probably the same as elsewhere in the world.     

Pineal cysts: an incidental MRI finding?

The incidence of pineal cysts (PC) in "standard" MRI was reviewed. Seven cases of PC were found from 400 consecutive MRI examinations. PC did not produce clinically relevant symptoms in any of the patients. Our data, as well as those emerging from a critical review of the literature, suggest that PC are often asymptomatic and represent an incidental MRI finding.     

Bilateral traumatic extradural haematomas: report of 12 cases with a review of the literature.

We are reporting 12 cases of traumatic bilateral extradural haematomas. The incidence was 4.8% of all cases of extradural haematomas. The most common site was the frontal region. CT scan examination was necessary for early diagnosis. Ten patients were operated upon while one patient was treated conservatively. Two patients died. The relevant literature is reviewed.     

Epilepsy and EEG in the elderly

Seizures are now the third most frequently encountered neurologic problem in the elderly population. The incidence of recurrent unprovoked seizures peaks in older patients. Because of this age-related increase and the growing elderly population, evaluation and treatment of the elderly patient has received increasing attention. This article focuses on epilepsy, not acute seizures in the elderly. The causes and types of epilepsy older individuals experience are reviewed, along with the diagnostic role of EEG. Treatment options are briefly addressed.