Biomedical subjects
Publications and source records attributed to C Loeb.
Carbamazepine-induced cardiac conduction disturbance is reported in 2 patients suffering from epilepsy. The cardiac defects disappeared in both patients after carbamazepine was discontinued, and reappeared in 1 patient after treatment was resumed.
The effect of the combined administration of gamma-aminobutyric acid (GABA) and phosphatidylserine was evaluated in a pilot study of 42 patients with drug-resistant epilepsy. The group included patients with complex partial seizures, simple partial seizures and absence seizures. Patients with complex partial seizures and simple partial seizures showed no significant improvement; on the other hand, there was a remarkable decrease in absence seizures, linearly related to the dose of GABA and phosphatidylserine. Side effects occurred in 9 patients and were usually mild.
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The natural history represents a basic reference point for evaluating temporal profile of a disease as well as the effect of the employed therapy. The incidence and the risk factors of the subarachnoid hemorrhage due to single aneurysm are presented. In particular the survival rate and mortality are evaluated in conservative treated group versus radical surgery group. The most relevant factors that affect survival are: time and clinical grades of severity. The best chance of alternating overall mortality from subarachnoid hemorrhage due to aneurysm seems to be: surgery within 1-2 days or secondary prevention.
A follow-up study of 107 patients with lacunar syndromes has been performed using the analysis of the survival curves and the recurrence curves for new focal cerebrovascular acute episodes. At the end of the 7th year of follow-up, the survival rate of lacunar patients was 479 per 1000, lower than the survival rate of the normal population matched for sex and age (755 per 1000). A more severe prognosis was observed in subjects over 65 years of age, in patients with pseudobulbar syndrome, hypertension and higher degree of disability. The average recurrence rate for new cerebrovascular episodes was 4.74 per 100 patient-years, much lower than that in survivors from cerebral infarction.
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A parenteral penicillin model of epilepsy in the rat was investigated with the aim of evaluating its reliability. Behavioral and EEG patterns were strongly variable in a group of 100 rats injected with 1,000,000 IU/kg of penicillin i.p. Gross counts of spikes were Fourier transformed and grouped into two time windows in 24 out of the 100 rats. Analysis of variance applied to compare the two time windows showed a sufficient suitability of the phenomenon for antiepileptic drug testing purposes. Five subsequent injections of penicillin performed in 8 rats showed that a spontaneous decrease of the response takes place, preventing a crossover design in pharmacological analyses. Evans Blue studies demonstrated that there was not a breakdown of the blood-brain barrier; this model can be used for testing anticonvulsants unable to penetrate the blood-brain barrier.
The effect of a suspension of GABA and phosphatidylserine (PS), phosphatidylcholine, or phosphatidylethanolamine was studied on penicillin-induced epileptic activity in rats. GABA-PS significantly reduced the number of spikes, in comparison with either the other phospholipid compounds or normal saline. No effect was observed after GABA or PS administration alone. We suggest that the different effects probably depend on extracellular and intracellular factors.
The evaluation of headache in patients with transient ischemic attacks (TIA) has various sources of difficulty, the definition of TIA being the most relevant. The classical definition needs to be supplemented with a normal CT scan if a misleading diagnostic statement is to be avoided. The clinical features of 90 patients suffering from TIA and who had contrast-enhanced CT scans are reported. Headache occurred in 30% of the patients. Headache prevailed in patients with vertebrobasilar TIA compared with carotid TIA (p less than 0.05). Headache prevailed as a preceding (24 h) and/or concomitant sign compared with other neurological symptoms (77.8% of the patients). Headache was ipsilateral, in the anterior half of the head in the carotid TIA and in the posterior half of the head in the vertebrobasilar TIA. In about 50% of the patients generalized non-localized headache occurred. Headache usually preceded the neurological symptoms in cases of arterial occlusion (20 carotid, 3 vertebral artery), usually appearing during or after the attack in cases without arterial occlusion. Only 2 cases out of 20 with positive CT scan had headache. These two patients suffered from a rather large hypodense lesion. The other 18 patients showed lacunar lesions. Different hypotheses concerning the physiopathology of the headache associated with TIA are discussed.
We present a case of generalized chorea, with complete recovery, due to MRI-documented bilateral lacunar infarcts of the caudate nucleus, putamen, and deep frontal white matter. MRI is probably more sensitive than CT in disclosing small deep cerebral infarcts.
The clinical definition of transient ischemic attacks (TIAs), besides the ischemic pathogenesis is based (i) upon 24 h. duration and (ii) complete reversibility. The limit of 24 h. has been chosen arbitrarily and episodes clearing completely after more than 24 h. do exist. In addition TIAs lasting less than 5 min. would have a higher incidence of subsequent completed stroke. Complete reversibility has also been disregarded: ischemic attacks leaving slight neurological deficits or showing an hypodense area at CT scanning have been shown to have the same significance at TIAs. Different clinical definitions and classifications account for very different natural history features reported in the literature. Transient attacks may be conveniently assessed under the label of Reversible Ischemic Attacks (RIA) covering attacks of 24 h. duration (TIA) and attacks of more than 24 h. duration (Protracted Transient Ischemic Attacks. PTIA). Terms such a RIND or PRIND (Reversible Ischemic Neurological Deficit or Prolonged Reversible Ischemic Neurological Deficit) should be disregarded since they are too general terms covering both cases with 24 and more than 24 h. duration. TIAs and PTIAs should be characterized by a complete clinical regression and normal CT, to avoid relevant wrong diagnostic statements (transient attacks in cases of lacunar stroke, hemorrhages, tumours); where clinical regression is partial and/or CT shows low attenuation areas the case should be labelled as one with partial non progressing stroke (PNS) or minor stroke. The question however arises whether TIA, PTIA or PNS significantly differ from each other from the clinical, prognostic and therapeutic standpoint or, on the contrary, any attempt to differentiate them on these grounds should be considered futile as suggested be Caplan (1983).(ABSTRACT TRUNCATED AT 250 WORDS)
A clinicopathological study of a patient with a 'locked-in syndrome' due to an acute inflammatory polyradiculoneuropathy is reported.
CSF endorphins levels have been measured in neuropsychiatric patients, in relation to controls. The results we obtained don't allow us to suggest any specific pathophysiological role to endorphins; their levels seemed to be modified in relation to a generic stress-response.
Two groups of 30 multiple sclerosis (MS) patients were randomly treated with corticotrophin (ACTH) and "bolus" 6-methylprednisolone (B/6-MP) to compare the effectiveness of the two treatments. Both ACTH and B/6-MP showed a similar effect, improving acute neurological deficits of MS patients without modifying the long term course of the disease. B/6-MP, showing prompt effectiveness and lack of side effects, may be regarded as a useful alternative to conventional treatment of MS.
The natural history and follow-up (5-7 years) of 76 patients with transient ischemic attacks (TIA), 45 patients with protracted transient ischemic attacks (PTIA), 85 patients with minor strokes (labelled as partial nonprogressing stroke; PNS) has been studied with the purpose of a comparative evaluation, since TIA, PTIA and PNS are often grouped together. Multiple attacks significantly recurred more frequently in patients with TIA and PTIA with respect to those with PNS. Patients with PNS significantly survived the follow-up with respect to patients with TIA and PTIA. At present, the distinction into TIA, PTIA and PNS should be maintained. Vascular surgery in cases with PNS should not be regarded a reasonable therapeutic strategy except in some individual cases.
We studied Sprague-Dawley rats with spike activity and myoclonus after intraperitoneal injections of penicillin. Twenty minutes after penicillin injection, one group received a random crossover treatment by intraperitoneal GABA (gamma-aminobutyric acid) or liposome-entrapped GABA (LEG) or phosphatidylserine alone. The other group received GABA, LEG, or phosphatidylserine followed 15 minutes later by the injection of penicillin. LEG decreased or prevented the epileptic activity, whereas no significant changes were seen with either GABA or phosphatidylserine given alone. LEG may enhance penetration of GABA across the blood-brain barrier because of the carrier action of the liposomes.
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