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Biomedical subjects

A D Rothner

Publications and source records attributed to A D Rothner.

At least 19 recordsLinked to original sources
PubMed1998

Worsening seizures after surgery for focal epilepsy due to emergence of primary generalized epilepsy.

Our patient underwent right anteromesial temporal resection at 17 years of age for intractable complex partial seizures due to hippocampal sclerosis, and then developed juvenile myoclonic epilepsy after a change in medication. Postoperative seizures ceased after a change to valproate monotherapy. Our patient reminds us to remain aware that generalized and focal epilepsy may coexist as an unusual cause for surgical failure. We feel that these patients may still be favorable candidates for epileptic surgery, as long as the focal epileptogenic zone is amenable to resection and the generalized epilepsy appears to be readily controllable.

Adolescent↗
PubMed1996

Renal manifestations of tuberous sclerosis complex.

Patients with tuberous sclerosis complex (TSC) are at increased risk of renal disease, predominantly angiomyolipomas and renal cysts. We retrospectively reviewed clinical data of 71 patients diagnosed with TSC. Progression of renal lesions was noted. TSC patients with renal lesions were compared with TSC patients without renal disease. Fifteen of 38 patients had renal abnormalities by imaging at presentation. Six of 9 with initially normal kidneys subsequently developed new lesions. Although not of statistical significance, there was a trend toward increased retinal hamartomas, cardiac rhabdomyomas, and skin lesions in those patients who also had renal abnormalities. Renal disease should be considered and sought in all patients with TSC, both at initial presentation and subsequently, since renal disease is a very significant cause of morbidity and mortality.

Adolescent↗
PubMed1995

Retinal changes associated with neurofibromatosis 2.

INTRODUCTION: Neurofibromatosis (NF) is now known to be more than one disease. NF2, formerly classified as central neurofibromatosis, is characterized by bilateral vestibular schwannomas, previously termed "acoustic neuromas", and is much less common than NF1. Lens opacities at an early age have been described in approximately 85% of NF2 patients. PURPOSE: To determine the frequency of retinal abnormalities in NF2 patients. METHODS: We prospectively examined 15 consecutive patients who met the diagnostic criteria of NF2. RESULTS: We observed an epiretinal membrane in the macular or paramacular area in 12 of 15 patients, and a combined pigment epithelial and retinal hamartoma in the macula of one patient who also had an epiretinal membrane in the macula of the other eye. Additionally, 11 patients had central posterior cortical, subcapsular, or peripheral cortical lens opacities. CONCLUSIONS: Children or young patients with epiretinal membranes, combined pigment epithelial retinal hamartoma, and lens opacities that are not the result of other ocular disorders should have a neurologic evaluation and a careful family history for NF2.

Adolescent↗
PubMed1995

Supplementary motor area seizures presenting as stumbling episodes.

A healthy young boy presented with brief stumbling episodes of recent onset. Evaluation with prolonged EEG-video monitoring led to the diagnosis of supplementary motor area epilepsy. Focal seizures arising from the medial fronto-parietal cortex may present unusual diagnostic pitfalls in their clinical semeiology as well as their EEG characteristics.

Brain Mapping↗
PubMed1995

The evaluation of headaches in children and adolescents.

The importance of a thorough evaluation of each patient with headache is stressed. Details of the data base, pertinent information regarding the physical examination, and thoughts concerning selection of laboratory tests are provided. The majority of headache types seen in pediatric practice can correctly be identified using these methodologies.

Adolescent↗
PubMed1995

Chronic nonprogressive headaches in children and adolescents.

Chronic nonprogressive headaches are common in adolescents. The features of this syndrome are distinct from those of migraine. Chronic nonprogressive headaches have received less attention and study than migraine headaches. The prevalence of this syndrome is not clear. A structured psychological interview with the patient and the parents of the patient coupled with psychological testing of the patient will usually identify factors playing a role in the continuing headache. Counseling, biofeedback, and cognitive training, combined with judicious use of medication, will frequently lead to resolution of the headache.

Adolescent↗
PubMed1995

Miscellaneous headache syndromes in children and adolescents.

This article reviews headache syndromes that are uncommon and not discussed in previous articles in this issue. Cluster, temporal-mandibular joint dysfunction, occipital neuralgia, and indomethacin responsive headache, as well as several other syndromes, are discussed. Proper identification of these disorders often leads to specific treatment, resulting in dramatic relief of discomfort and pain.

Adolescent↗
PubMed1995

Pathophysiology of recurrent headaches in children and adolescents.

The classification and pathophysiology of headache syndromes in children and adolescents is reviewed. The most important issues are classifying the headache type and determining the etiology of the child's headache. This is best accomplished with a thorough history and physical examination, coupled with selected laboratory tests. The pathophysiology of the underlying headache as reviewed usually will allow the choice of appropriate treatment modalities.

Adolescent↗
PubMed1993

Management of headaches in children and adolescents.

Deciding whether a child's headache is functional or organic is difficult for even the experienced physician. This review examines the diagnosis and management of headache syndromes in children and adolescents. A systematic history and examination together with selected laboratory data will enable the practitioner to establish the correct diagnosis.

Acute Disease↗
PubMed1993

Epilepsy in the setting of neurocutaneous syndromes.

The neurocutaneous syndromes are characterized by congenital dysplastic abnormalities involving the skin and nervous system. The commonest neurocutaneous syndromes manifesting epilepsy are tuberous sclerosis and the Sturge-Weber syndrome. Neurofibromatosis and other lesser-known entities, such as epidermal nevus syndrome, are also known to be accompanied by epilepsy. These syndromes are not related to one another. This article reviews what has been learned about the epileptic syndromes in these disorders.

Adolescent↗
PubMed1992

Ocular findings associated with neurofibromatosis type II.

BACKGROUND: Neurofibromatosis has been recently acknowledged as consisting of a number of different diseases. Neurofibromatosis (NF) type I and NF type II are the most clearly defined. Type II is characterized by bilateral acoustic neuromas and is rare (its incidence is 1/50,000). The previously reported ocular associations of NF type II are posterior subcapsular cataracts, Lisch nodules, and combined hamartomata of the retinal pigment epithelium and retina. In this study, the authors attempt to define further the ocular manifestations of NF type II. METHODS: The authors prospectively examined 9 patients who met the diagnostic criteria for NF type II (age, 18 to 38 years; mean, 25 years). RESULTS: Seven of nine patients had epiretinal membranes in the posterior pole. None of these epiretinal membranes were visually significant. In addition, five patients had central posterior cortical cataracts and five had peripheral wedge-shaped cortical cataracts. CONCLUSION: The presence of epiretinal membranes in young patients may represent another clinical finding associated with NF type II. Epiretinal membranes, central posterior cataracts, peripheral cortical cataracts, or combined hamartoma of the retinal epithelium and retina in young patients should alert the ophthalmologist to include NF type II in the differential diagnosis in patients with stigmata of NF type II.

Adolescent↗
PubMed1991

Headaches in adolescents. Diagnosis and management.

A thorough history, general physical examination, neurologic evaluation, and charting of the temporal pattern of the headache will allow the correct diagnosis to be made under most circumstances. Laboratory testing is tailored to the specific headache syndrome. Psychological factors are important in all forms of adolescent headache and should be evaluated in each and every case. Once the correct diagnosis has been made, a comprehensive approach to the patient's problems, medical and psychological, will usually result in improvement.

Acute Disease↗
PubMed1991

A practical approach to headaches in adolescents.

A thorough history, general physical examination, and neurologic evaluation coupled with the charting of the temporal pattern of the headache will allow the correct diagnosis to be made under most circumstances. Laboratory testing is tailored to the specific headache syndrome. Psychological factors are important in all forms of adolescent headache and should be evaluated in each and every case. Once the correct diagnosis has been made, a comprehensive approach to the patient's problems will usually result in improvement.

Acute Disease↗
PubMed1990

Psychogenic seizures in children and adolescents: outcome after diagnosis by ictal video and electroencephalographic recording.

Psychogenic seizures in 21 nonepileptic children and adolescents, aged 8 to 18 (mean 14.5) years, were recorded by means of video recording and electroencephalography. The episodes included thrashing movements, limb jerking, or staring, with unresponsiveness. Ictal and interictal electroencephalograms showed no abnormalities after antiepileptic medication was discontinued. Fifteen patients had psychogenic seizures spontaneously during recording, and six had seizures in response to suggestion and intravenous saline injection. After the video-electroencephalographic evaluation, patients and families were told that the episodes were emotional in origin. All patients but 1 agreed to remain without antiepileptic medication, and 16 patients (76%) agreed to begin psychiatric treatment. At 6 to 66 (mean 30) months' follow-up, 14 of 18 (78%) were free of episodes. These data indicate that the majority of young patients with psychogenic seizures have a good outcome. A firm diagnosis is critical so that the episodes can be classified and emphasized as medically not worrisome, permitting a shift away from antiepileptic medication and toward psychiatric treatment.

Adolescent↗