Controversies In Neurology Research Articles

Medical Treatment of Cysticercosis: Ineffective vs Effective

In the section Controversies in Neurology of the January issue of theArchives, Kramer 1 and Del Brutto 2 do a commendable job of defending opposed positions about the role of antiparasitic therapy in the management of neurocysticercosis. We would like, however, to discuss the final statements of the section editor, Dr Hachinski, 3 that placebo-controlled therapeutic trials for neurocysticercosis are not plausible for ethical reasons. The actual knowledge of the evolution of untreated cysticercosis is scarce and based on anecdotal case reports. 4,5 Selection bias affects the validity of these reports: cases with more severe symptoms will be more likely to be chosen for study since patients with milder symptoms will be less likely to seek medical attention. Historical controls (patients who had computed tomographic studies performed before treatment) have also shown that lesions do not significantly increase in number or size. 6,7 These historical controls were selected from

First Seizure Management--Reconsidered

Among the 24 invited controversies published in theArchives, none has generated more interest or passion than the management of a first seizure. Part of the explanation for such vehemence may be that the controversy combines the difficulty of making a diagnosis with the uncertainty of prognosis and with differing physicians' philosophies as to how to handle both. The three viewpoints advanced in this revisited controversy elaborate on points made more directly and less diplomatically to the Editor of CONTROVERSIES IN NEUROLOGY by others. Although the aim of CONTROVERSIES IN NEUROLOGY is to focus and simplify important issues, it would be unwise to force consensus where the evidence does not allow it, so that the above viewpoints are offered without editorial comment. Einstein is alleged to have admonished that we should try to make things as simple as possible, but no simpler.

First seizure management--reconsidered. Response III.

This article is in response to a recent CONTROVERSIES IN NEUROLOGY 1 dealing with the question of the appropriate treatment of a person who has a single seizure. Although considerable epidemiologic information was given in the original series of articles, I would like to propose a different risk/ benefit analysis to the situation and outline one epileptologist's approach to the problem. When a person presents to the doctor after having had a spell, it is incumbent on the physician to arrive at the appropriate diagnosis. In diagnosing a seizure and/or epilepsy, I refer to the International Classification of Seizures 2 and a recently published classification of epilepsy 3 as a guideline. The history of the event obtained from the patient and an observer will produce an accurate diagnosis 95% of the time. The occurrence of a single primarily generalized convulsive seizure may be due to exogenous events such as

Controversies in neurology Edited by R. A. Thompson and J.R. Green New York. Raven Press, 1983 190 pp. illusrtrated, $42.50

Controversies in neurology Edited by R. A. Thompson and J.R. Green New York. Raven Press, 1983 190 pp. illusrtrated, $42.50