Episodic Manifestations Research Articles

Psychogenic seizures

Psychogenic seizures vary in clinical manifestations and the manifestations of individual episodes may be similar to those of epileptic seizures. Even persons expert in differentiating psychogenic and epileptic seizures may have difficulties in determining the nature of a particular episode. Patients with psychogenic seizures often do not have epilepsy. If epilepsy and psychogenic seizures are thought to coexist, careful documentation of the presence of both disorders should be obtained. The etiology of psychogenic seizures varies from patient to patient. Consequently, the optimal treatment varies correspondingly.

Episodic arthritis, skin manifestations and immune complexes following intestinal by-pass operations for morbid obesity.

A systematic search for immune complexes (IC) in blood and skin revealed no correlation to IC-related disorders in 35 patients who had undergone jejunoileal bypass for obesity. Tests for cryoprecipitates and endotoxins proved negative.

Fall in immune complex levels during gold treatment of rheumatoid arthritis.

Prior to starting gold treatment 30 patients with rheumatoid arthritis had an elevated mean level of circulating immune complexes measured by Clq binding activity. Gold treatment led to an improvement in disease reflected by significant falls in erythrocyte sedimentation rate (p less than 0.001), C-reactive protein (p less than 0.01), Ritchie articular index (p less than 0.001), and duration of morning stiffness (p less than 0.05). Concurrently immune complex levels fell, and this change first reached significance after 3 months' treatment (p less than 0.05). Serum Clq binding activity was not related to clinical and laboratory measurements of joint inflammation. This suggested to us that there is no direct immunopathological relationship between circulating immune complexes and joint inflammation in rheumatoid arthritis. Serum Clq binding activity was strongly related to IgM-RF levels measured at latex titre (r - 0.7, p less than 0.001). Removal of immune complexes from serum with Sepharose 4B-staph A (staphylococcal protein A) led to a fall in IgM-RF from 2 mg/ml (2 g/l) to 0.4 mg/ml (0.4 g/l). This suggests that the reason for the relationship between Clq BA and IgM-RF is that, on average 80% of serum IgM-RF exists as part of immune complexes containing IgG.

Childhood Epilepsy: A Pediatric-Psychiatric Approach

Childhood epilepsy, like that in the adult, was once managed by merely prescribing a drug or a combination of drugs, titrating them until an optimum effect was achieved. Little if any consideration was ever given to the total care of that patient. Now in the case of a child with seizures, this ongoing deficit of the past has been better recognized, and aggressive efforts are now made to treat other associated handicaps, to include scholastic, social, and emotional problems in that youngster. This premise is embodied in the present lucid, concise, ambitious little volume. The authors recognized that this symptom complex has numerous etiologic factors, and that the episodic manifestations depend on which part of the brain is involved, as well as on those routes over which the abnormal paroxysmal discharges are dispersed within the CNS. A charming historical introduction with clever linkage to psychoanalytic precepts indicates to the reader

Phenomenological and pharmacological identity of audiogenic-sensitive state in animals treated with methionine sulfoximine and in genetically audiogenic-seizure-susceptible animals.

The phenomenon of sound-induced, or audiogenic, “seizure” has been recognized in mice, rats, guinea pigs, and rabbits. Evidence to date indicates that there are a variety of genetic situations, at least in the house mouse, predisposing to susceptibility to audiogenic seizures [1]. However, this phenomenon remains a biological curiosity uninterpreted so far in terms of fundamental biological concepts, in spite of the presence of about 600 research reports on this particular problem. We became interested in this particular phenomenon following our discovery of an audiogenic susceptibility of animals treated with methionine sulfoximine (MSI). This agent, the toxic principle of agenized flour, is of considerable neurobiological interest since it produces in some mammalian species a complex syndrome characterized by peculiar behavioral episodes and convulsive seizures associated with certain autonomic manifestations. Episodic running behavior (ERB) is the most characteristic and constant feature in MSI-treated animals. This episode begins with the obvious manifestation of fear or apprehension followed by flight or escape-like behavior with wild running, leaping, and jumping movements. Subsequently, the animal may develop either a stuporous catatonic state or generalized convulsions. During the past three years, our attention has been focused on the fact that a striking phenomenological similarity exists between some of the episodic behavioral manifestations of MSI-treated animals and genetically audiogenic-sensitive animals.

Effect of atropine and eserine on the episodic behavioral and electrographic manifestations induced by methionine sulfoximine

The effects of eserine and atropine on the sound-induced episodic behavioral manifestations were examined in sixteen cats and forty rats treated with methionine sulfoximine (MSI). Behaviorally, eserine markedly increased the frequency of sound-induced fright behavior and episodic running (ERB) with or without associated convulsion in cats, and of ERB in rats. Atropine markedly reduced the frequency of sound-induced ERB in both cats and rats but increased generalized convulsions only in cats. Electrographically, both auditory stimulation and eserine produced low-voltage irregular fast EEG patterns in MSI-treated cats. No organized electrographic seizure discharge was observed during ERB but was noted during the stuporous cataleptic state following ERB in one cat. There was no depression of electrical activity following ERB or of the electrographic seizure following ERB. Atropine produced a high voltage irregular slow EEG pattern, which was not modified by auditory stimulation. The generalized convulsions developed only when the EEG pattern was of high voltage slow activity. It began with focal spike discharge in the amygdala and in the hippocampus or pyriform cortex, or both, correlated with facial twitching which built up into an organized seizure with progressive propagation into widespread brain areas coincident with generalized convulsion. There was a profound post-ictal electrographic depression. These findings further strengthen our view that ERB in both MSI-treated cats or rats and genetically-determined audiogenic sensitive rats is an identical phenomenon. In addition, it is suggested that ERB is coincident with excitation, and the generalized convulsion is coincident with blocking of the cholinergic mechanism involved in the ascending neuronal transmission of the brain stem reticular system.

CYST OF THE PULVINAR OF THE THALAMUS

The following case is reported because of a particularly puzzling clinical course in which the glycosuria and hyperglycemia varied in intensity with the intensity of clinical manifestations of episodes of internal hydrocephalus. At autopsy, a fluctuant cyst of the pulvinar of the thalamus obstructing the aqueduct of Sylvius was found. In addition, there appeared other symptoms and signs, some of which are explained on the basis of a detailed anatomic analysis of the central nervous system. REPORT OF CASE L. M., a white woman aged 63, was admitted to the Hamilton County Home and Chronic Disease Hospital on June 27, 1936 and died on August 25, 1936. There was mental confusion, making it difficult to obtain a satisfactory history from the patient. The husband stated that up to ten years prior to admission to the hospital the patient had been normal, with normal speech, emotions and mentality. Approximately ten years

Is there an increased suspension stability of the erythrocytes in allergic disease?

The data presented in this study seem to support the idea of an increased suspension stability of the erythrocytes in allergic disease. The sedimentation rates of all patients with allergic disease used in this study are all slower than the theoretical mean of the range, 2 mm. to 12 mm. in one hour, generally accepted for normals, nor do they spread over this range. It seems probable that the accepted normal range has been established from studies which did not exclude allergic individuals. The probability that this is true receives support by Vaughan's 10 recent report that upward of 10 per cent of the population develop major allergic manifestations and approximately an additional 50 per cent give a history of minor episodic allergic manifestations in the past. Further investigation of normal rates is needed, with care to exclude those individuals with major and minor allergies in the personal history as well as those who have close relatives so affected.

THE CHRONIC FORM OF MENINGOCOCCUS MENINGITIS

Cerebrospinal meningitis with a prolonged course presents two varieties. In one we observe only recurrences or episodic meningeal manifestations. Here the patient during the intervals appears to be in perfect health. Nevertheless, suddenly or insidiously the symptoms return either in a slight or grave form. The intervals may last either a few days or a few weeks. The other variety which is the subject of the present contribution, concerns cases of cerebrospinal meningitis the evolution of which is continuous. While in the literature are mentioned a few such isolated cases under different captions, nevertheless their chief characteristic features have not been sufficiently emphasized by various authors with the exception of Robert Debre, pupil of Netter. In 1845 Tungel 1 for the first time speaks of disturbances in the brain tissue proper in the course of a prolonged case of cerebrospinal meningitis. The next two earliest records we find by Rilliet 2 and

Morbid Impulses from the Medico-Legal Standpoint

The study of morbid impulses is very important because of the graves consequences to which they may lead from social and medicolegal standpoints. Such a study presents multiple interesting features. First of all, the underlying basis upon which these morbid states develop. Since Morel the question of heredity began to play the most important role in the domain of mental pathology. It finds its corroboration also in the study of Mendelian laws of heredity.3 Morbid impulses constitute episodic manifestations in the life of neurophatic individuals. What is neuropathy ? Under this term is understood a pathological state of an individual whose psychophysical resistance is constitutionally diminished; in other words, it is a condition which is a deviation from the normal type of humanity. In such a person there is an interruption of harmonious equilibrium existing between various functions of cerebrospinal centers; the co-operation and adaptation of the latter are incomplete. There is an ataxia of thought, of sentiment, of will, of psychomotor functions. According to the parts involved these patients form several groups which are only apparently different from each other, but under which is hidden the same individuality, viz., the neuropath. The most important characteristic features in neuropathic inddividuals are found in their psychical sphere. The development of their intellectual faculties is irregular and there is a want of equilibrium in these faculties. Such individuals are only partial, incomplete beings. They may have a remarkable memory but cannot fix their attention. Their mental instability is sometimes extreme. At the same time they may be apathetic and present paroxysms of great excitability. They may be eccentric, dreamers, with romantic tendencies. They are emotional, timid, extremely sensitive, impressionable, suspicious, egotistic, haughty and may be affected with moral perversity of the gravest