Epileptic patients refractory to drug therapy

We compared two groups of patients with idiopathic epilepsy, 41 patients whose seizure frequency was not controlled by adequate therapy and 39 patients in good seizure control, in respect of hematology, kidney and liver function tests, serum IgG, IgA and IgM concentrations and drug concentrations. The only difference that emerged were in the serum immunoglobulins, which were raised in the drug refractory group, significantly (p less than 0.01) so in the case of IgG. Failure of seizure control did not depend on inadequacy of drug dose or of blood concentration. Although the serum Ig changes do not warrant the assumption of an immunological origin for drug resistance, they do suggest a useful research line.     

Plasma uric acid in patients receiving anticonvulsant monotherapy

In newly diagnosed adult patients with epilepsy followed prospectively on monotherapy, carbamazepine and phenytoin were associated with a fall in plasma uric acid, but sodium valproate and phenobarbitone were associated with a rise in plasma uric acid. The mechanisms and significance of these findings are discussed.     

Child psychopathology and environmental influences: discrete life events versus ongoing adversity

Patterns of exposure to distinct types of life stressors were compared between 134 children attending a military child psychiatric clinic and a matched military community control sample. Compared with the community sample, clinic-referred children had experienced significantly higher levels of normative stressful events as well as events confounded with their own adjustment and events related to parental psychosocial functioning. Differences in levels of normative stressful events were no longer significant, however, when controlling for events related to parental functioning. Ratings of stressful events during the past year significantly underestimated the lifetime stress exposure differences between clinic and community control children. Although normative stressful events, parent-related events, and parent symptomatology ratings were significantly related to child behavior problem ratings, normative stressful events did not contribute to predictions of child behavior problems beyond the variance attributable to parent-related events and parent symptomatology. Implications of these findings for life stress and child maladjustment research are discussed.     

Current status of research activity in American child and adolescent psychiatry: Part I

A survey of research activity of American academic child psychiatrists was completed in February, 1989. The survey demonstrated an increase in research activity since the 1983 report in the Current Status of Child Psychiatry. A definition of a researcher was derived from a study of internists and general psychiatrists and applied to the 488 respondents (78.5% of sample), and it was found that males outnumber females and that researchers contribute significantly more to the literature and education than nonresearchers. Early research exposure and mentoring are important influences on a research career. Recommendations by researchers for future training of researchers are presented. Periodic surveys are encouraged.     

Current transition assessment practices.

Although researchers have called for a movement away from prediction-related assessments to those which identify specific skill deficits, the extent to which professionals responsible for vocational assessment have shifted their focus is uncertain. The purpose of this investigation was to assess the frequency with which specified prediction-related and skill deficit-related vocational assessment procedures were administered by a sample of secondary-level teachers and employment training specialists. Additionally, the frequency with which these professionals used assessment data to aid in decision making was determined. The results revealed that teachers and employment training personnel used a variety of assessment procedures to make transition decisions. The implications of these findings are discussed.     

Stiff-man syndrome: an immunopathy?]

The discovery of autoimmune processes in the stiff-man syndrome (SMS) not only raises questions concerning the syndrome itself, but may also lead to new insights into pathogenetic principles of neurological disorders. Autoantibodies against GAD, the GABA synthesising enzyme, may become a helpful (though not specific) diagnostic tool, and furthermore may serve as a plausible explanation for both the symptoms of the syndrome and the delayed development of type I diabetes mellitus. However, it remains unexplained why autoimmunity against such widespread inhibitory transmitter systems should induce a syndrome which by definition is confined to only a few symptoms, and for which the majority of neurological signs are regarded as exclusion criteria. It is therefore hypothesised that SMS is part of a broad spectrum of encephalomyelopathies with autoimmunity against GABAergic neurones in common, but with a heterotopic manifestation. Progressive encephalomyelitis with rigidity may be an extreme variant within this spectrum.     

Hemispheric activation vs spatio-motor cueing in visual neglect: a case study

We report a case of mild visuo-spatial neglect consequent upon right-hemisphere stroke. At the time of testing, the patient had a complete left visual field deficit but only a very slight left hemiparesis. Under conventional testing conditions, line bisection performed with the right hand showed more severe left neglect than when performed with the left hand. This pattern of performance could, however, be modified, both quantitatively and qualitatively, by changing the starting position of the patient's hand when bisecting horizontal lines. The results suggest that spatio-motor cueing has a more profound effect upon task performance than does differential hemispheric activation per se. We also provide a demonstration that, in a normal subject, the starting position of the hand is likewise a crucial determinant of task performance. In this case, however, there is also an interaction between the hand (and hence hemisphere) deployed and the position of that hand in space.     

Differential distribution of pepsinogen II between the zones of the human prostate and the seminal vesicle

Pepsinogen II (PG II) is a gastric proenzyme which has previously been found in both human seminal fluid and the prostate gland. However, no regional distribution of PG II has been noted within the prostate nor has it been found in the seminal vesicle. Bouins-fixed sections of central zone, peripheral zone and seminal vesicle, taken from 10 prostates removed at radical prostatectomy or cystectomy, were exposed to antibody against PG II and stained using the A-B-C immunoperoxidase technique. Formalin-fixed tissue from autopsy prostates of four men in the third decade, and six cases with BPH nodules, were also examined for PG II activity. In nine of 10 seminal vesicles, and seven of 10 central zone samples, more than 50 per cent of the cells stained positive for PG II. By contrast, in nine of 10 peripheral zone samples staining was present in five per cent or less of the epithelial cells. Similarly, PG II activity in the four autopsy prostates occurred almost entirely within the central zone and ended abruptly at the boundary between the peripheral and central zones. BPH nodules contained no PG II activity. These findings provide the first evidence that the central and peripheral zones may serve different biological functions. Embryologically it is currently thought that the prostate is of endodermal origin and the seminal vesicle of mesodermal origin. The presence of large amounts of PG II in both the seminal vesicle and central zone lends support to the hypothesis of a common mesodermal origin for these two structures.     

Extension to the ultrasonic study of supra- and subphrenic spaces of plate-shaped probes initially destined for intracavitary sonography. Research on thoraco-abdominal fluid collections in non-mobilizable patients

The authors describe an original application of real time transducers--initially intended for intracavitary sonography--in thoraco-abdominal scanning. The stic-form probe can be easily slipped under the patient. It is then possible to realize a scan with an upward beam. In the postero-anterior scan, the patient is placed in a supine position. He is motionless. We achieve a better visualization of the liquid collections, since their accumulation is declivious. The method allows a wider sonographic window for thoraco-abdominal and diaphragmatic investigation in sonography.