The Oregon experience: a point of view

What has not been addressed is how Oregon will maintain and expand the early breakthrough of the statewide consensus dialogue that created the "list" of prioritized medical conditions.     

Performance in the cat's visual system: a behavioural and neurophysiological analysis

Behavioural research, neurophysiological experiments and computer simulations are used in an attempt to analyze pattern recognition in the cat's visual system. The methods were chosen in such a way that the measurable performance data resulting from behavioural and neurophysiological experiments can be combined simply. It is shown that, with minor modifications, the methods can be adapted to every estimation and detection problem like pattern discrimination, movement detection and to the assessment of lesion effects, so that they are widely applicable. The system analysis permits the correct prediction of behavioural experiments and an approximate assignment of functions to the areas 17, 18 and 19 for the task set.     

The AWS from a parent's point of view:

The parents of 36 people with mental handicaps were interviewed concerning their views on more integrated services for their relatives. Most were in favour of such developments, but considerable opposition was expressed in a number of areas, especially in relation to day care and education. Parents of those with more severe handicaps tended to be least in favour of integration. Some implications for consumer involvement in the AWS are discussed.     

Multiple sclerosis: From a myelin point of view

Multiple sclerosis (MS) is a demyelinating disease during which an autoimmune reaction is directed against oligodendroyctes. Alterations of normal myelin structure or oligodendrocyte metabolism may be primary events that influence the susceptibility to MS. Once triggered, the immune system attacks and destroys myelin and the myelin forming cell. Evidence is presented that the oligodendrocyte responds to the attack by immune cells and their secreted products through modulation of its metabolism and gene expression. Cytokines, immunoglobulins, and complement complexes may elicit a survival response in the oligodendrocytes, involving the induction of heat shock proteins and other protective molecules. The possibility of manipulating these complex glial cell functions and controlling their pathologic interactions with immune cells will illuminate how myelin damage can be contained and how the injured tissue can be repaired. © 1996 Wiley-Liss, Inc.     

Development of visual function in hemihydranencephaly

This study reports on the findings of longitudinal follow-up of visual function in a 12-year-old girl affected by congenital right hemihydranencephaly. This extremely rare unilateral brain malformation allowed the authors to gather new information on neuronal plasticity and functional compensations of the visual system across a period of 10 years. An extension of the preserved right visual hemifields above the middle line and strategical eye or head positions developed to increase visual functions are discussed. In addition, ophthalmological and orthoptical findings, as well as the development of monocular grating and linear acuity, are described.     

The unidimensionality of a psychiatric scale: a statistical point of view

In quantitative psychopathology, one of the most crucial questions is whether a set of items measure just one thing in common. This property may be defined as unidimensionality. After a formal definition of unidimensionality, this paper discusses the use of the different tools traditionally related to this area. For quantitative measurements, factor analysis remains a good approach, goodness-of-fit tests, however, are of questionable value. Cronbach's alpha coefficient is more related to reliability than unidimensionality. The scree plot and the proportion of variance accounted for by the first principal component are, in practice, interesting tools. Item response theory leads to models that require unidimensionality to obtain efficient estimates of latent attributes; these methods, however, are not really adapted for assessing the unidimensionality of a set of items. Finally, even if unidimensionality is a fundamental psychometric property, there is a need for general multidimensional instruments that reflect the heterogeneity of psychiatric disorders. Copyright © 1999 Whurr Publishers Ltd.     

Subtypes of temporal lobe epilepsies: a clinical point of view

We studied 40 patients with temporal lobe epilepsies who had long-term intracranial EEG recordings and temporal lobectomies. They were divided into 3 groups on the basis of the anatomical site of seizure origin. An electrode implantation technique combined intracerebral depth electrodes with subdural strip electrodes. The seizures were of amygdalo-hippocampal origin in 18 patients, lateral temporal in 13 patients, and temporo-basal in 9 patients. The clinical and EEG features were reviewed retrospectively with regard to 3 factors in each patient: localization of interictal spikes in the scalp-recorded EEG, signal symptoms (auras), and presumed etiologies. Epilepsy with amygdalo-hippocampal and lateral temporal seizures was found to be distinguishable by the electroclinical features. It seems practical to classify these 2 subtypes of temporal lobe epilepsies as in the 1989 Classification of Epilepsies and Epileptic Syndromes. Temporal lobe epilepsies thus defined can be regarded as epileptic syndromes rather than a cluster of seizure manifestations.     

Empowering strategies: the physician's point of view

This paper proposes that the healing suggestions we create when utilizing psychotherapy with hypnosis reflect the current dominant cultural belief systems. Since Western medicine is founded on and continues to rely on the model of patriarchy, then it is not surprising that common hypnotic metaphors reflect this mindset, best represented by the military metaphor. Because this very cultural view has been so damaging to women's health, continuing to utilize this same language only serves to perpetuate victimization and thus poor health. An entire shift in thinking about the way our culture views health and disease is already in progress and is explored as a source of new healing metaphors. This new healing paradigm may be especially beneficial for women's health as it emphasizes tapping into ones internal resources thus promoting self-worth and self-empowerment rather than giving up one's power in the name of modern western medicine.     

Brain function in the minimally conscious state: a quantitative neurophysiological study.

OBJECTIVE: To explore possible EEG power spectrum and coherence differences between patients in minimally conscious state (MCS) and patients with severe neurocognitive disorders (SND), who show signs of awareness. We also try to find EEG cortical sources that differentiate between both conditions using LORETA source analysis. METHODS: We studied 16 patients with traumatic brain injury (7 MCS, 9 SND; aged 18-49) and compared EEG power spectra, coherence, and LORETA sources at rest for both groups. RESULTS: EEG power spectra revealed significant differences in the delta range of both conditions. Patients in MCS showed a notably increased power in this band, compared to SND patients. LORETA analysis showed that posterior sources of delta and theta frequencies had higher amplitude in MCS patients than in SND patients. Regarding fast frequencies, lower source magnitudes in temporal and frontal lobes were found for MCS patients. CONCLUSIONS: Our results stress the importance of fronto-temporal-parietal associative cortices within the "awareness-regions" model. Our results also suggest a relation between excess of slow wave activity and diminished level of awareness in brain injury population. SIGNIFICANCE: Neurophysiological correlates in brain damaged patients who are severely impaired could be used to assess the integrity of brain areas responsible for awareness.     

What is needed from a neuropsychological point of view

This article discusses the neuropsychological aspects of surgery for epilepsy, and what is needed in EEG evaluation to permit the best use of neuropsychological data to help identify the most promising surgical candidates. Neuropsychological changes after surgery are first discussed, and it is noted that changes in memory are most important with less important fluctuations in intelligence and language and with other areas showing few or no changes. Emotional and psychosocial outcomes of surgery are dependent upon relief from seizures, with substantial relief being essential for improvement to be observed. Finally, it is noted that a combination of EEG and neuropsychological variables results in the best prediction of seizure relief, but reliable EEG data are critical to this effort. Obtaining such data frequently necessitates EEG monitoring, frequently with invasive electrodes. Such information often provides the clearest information and the best chance of assisting patients with epilepsy.     

Preservation of brainstem neurophysiological function in hydranencephaly

The preservation of central neurophysiological function was assessed in a 32-year-old woman with hydranencephaly using brainstem auditory evoked responses (BAER), auditory middle latency responses (MLR), cortical auditory evoked responses (CER), strobe electroretinograms (ERG), strobe-flash visual evoked responses (VER) and median and tibial nerve somatosensory evoked responses (SER). The BAER to the right ear stimulation revealed wave peaks I through VII with normal thresholds, morphology and latencies, while the BAER in the left ear was abnormal. The auditory MLR and CER were absent. Grossly normal strobe ERGs were acquired bilaterally with peak waves at 20 and 50 ms. Strobe VERs were poorly defined and abnormal bilaterally. Left and right median nerve SER revealed significant conduction defects in the large fiber sensory system caudal to the thalamus, above the lower pontine level. Bilateral tibial nerve stimulation revealed normal knee popliteal fossa potentials, but distinct conduction defects in the large fiber sensory system rostral to the lower spinal cord. Brainstem electrophysiological measures revealed functional auditory afferent tracts and nuclei, in the absence of cortical influence, suggesting intact unilateral auditory function, which would support clinical observations of behavioral auditory responses in hydranencephaly.     

Nosology of dementias: the neuropathologist's point of view

The diagnosis of degenerative dementias heavily relies on the identification of neuronal or glial inclusions. Tauopathy is probably the largest group including Alzheimer and Pick disease, mutation of the tau gene, progressive supranuclear palsy, corticobasal degeneration, and argyrophilic grain disease. Lewy bodies, when numerous in the cerebral cortex, are usually associated with the cognitive deficit of Parkinson disease dementia or of dementia with Lewy bodies--both conditions being distinguished by clinical information. The inclusions of the dentate gyrus, only labeled by anti-ubiquitin antibodies, isolate a subgroup of fronto-temporal dementia (FTDu), sometimes familial and sometimes associated with amyotrophic lateral sclerosis. Mutations of the progranulin gene have been recently discovered among a significant proportion of these patients. Neuronal Intermediate Filament Inclusion Disease (NIFID) is a rare, apparently sporadic dementia, characterized by the presence of large inclusions in the cell body of many neurons. These inclusions react with antibodies directed against neurofilaments or against other intermediate filaments (such as alpha-internexin). The diagnostic value of some of these inclusions allowing the classification of the degenerative dementias has been discussed. The link between the inclusions and the pathogenetic mechanism is indeed probably variable. It should however be stressed that whenever their composition has been elucidated, the inclusions have given important clues to the pathogenesis of the disease in which they had been found.     

Two cases of hemichorea-hemiballism with nonketotic hyperglycemia: a new point of view

Hemichorea-hemiballism (HCHB) is an usually continuous, nonpatterned, involuntary movement disorder caused by basal ganglia dysfunction, commonly due to a vascular lesion, described in nonketotic hyperglycemic patients. Particular computed tomography and magnetic resonance imaging findings have been described. The pathogenic mechanism of chorea arising during hyperglycemia and the nature of neuroimaging findings are unclear. In this paper we describe two elderly women with onset of HCHB during a hyperglycemic episode. The symptoms persisted in one of them after recovery of normal glycemia. The pathophysiological mechanism of the disease is discussed in the light of clinical and neuroradiological follow-up.