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Biomedical subjects

D W Chadwick

Publications and source records attributed to D W Chadwick.

At least 91 records · Page 5Linked to original sources
PubMed1986

Differences between neurological and neurosurgical approaches in the management of malignant brain tumours.

The management and outcome in 205 patients diagnosed as having cerebral gliomas over five years were reviewed. Patients referred to neurologists and neurosurgeons had similar clinical features and similar results on computed tomography. Patients referred to neurologists underwent burr hole biopsy less often and had better short term morbidity than patients referred to neurosurgeons, although final outcome was the same in both groups. Few patients underwent other surgical procedures. Referral for radiotherapy was usually by neurosurgeons, although this did not significantly affect long term survival. The implications for the management of patients with primary malignant brain tumours and the need for prospective studies are discussed.

Adolescent↗
PubMed1986

Arteriovenous malformations of the brain: natural history in unoperated patients.

Two-hundred and seventeen patients from a total population of 343 patients with arteriovenous malformations, were managed without surgery. Follow up was for a mean of 10.4 years. Using life survival analyses, there was a 42% risk of haemorrhage, 29% risk of death, 18% risk of epilepsy and a 27% risk of having a neurological handicap by 20 years after diagnosis in unoperated patients.

Adolescent↗
PubMed1985

Which drug for the adult epileptic patient: phenytoin or valproate?

A series of 140 previously untreated patients with tonic-clonic or partial seizures were randomised to receive either phenytoin or sodium valproate. There was no difference between the treatment groups in pretreatment variables that might influence outcome. Sodium valproate and phenytoin in the treatment of tonic-clonic or partial seizures showed no difference in efficacy as regards time to two year remission or time to first seizure. When the possible prognostic factors were studied, including history and results of clinical examination and investigations before treatment; the only factor which influenced the proportion of patients achieving two year remission was type of seizure. Patients with a clinical history of partial seizures did significantly less well than those with a history of tonic-clonic seizures only. This study showed no major difference in efficacy between sodium valproate and phenytoin in adults with recent onset of epilepsy, irrespective of the type of seizures that the patient suffered.

Adolescent↗
PubMed1985

Dipyridamole and postoperative ischemic deficits in aneurysmal subarachnoid hemorrhage.

Recent evidence has suggested that the delayed cerebral ischemic deficits that often follow surgery for aneurysmal subarachnoid hemorrhage (SAH) may be due to a proliferative vasculopathy. This vascular pathology may result from an interaction between the platelets and the vessel wall. A single-blind controlled trial of dipyridamole administration in 677 patients presenting with SAH (of whom 348 came to surgery) was undertaken to test the hypothesis that the modification of platelet behavior might reduce the incidence of ischemic deficits. Blind independent assessment of the outcome in the surgical group based on the Glasgow Outcome Scale and the specific neurological deficits revealed no significant differences between the control and treatment groups.

Blood Platelets↗
PubMed1984

Controlled trial of plasma exchange in acute inflammatory polyradiculoneuropathy.

A randomised controlled trial of exchange versus no exchange was conducted to find out whether plasma exchange would be useful in acute inflammatory polyradiculoneuropathy. It was calculated that 15 patients would be required in each group to demonstrate a worthwhile improvement in functional ability 1 month after completion of treatment. Treatment comprised five exchanges in 10 days (55 ml plasma/kg body weight/exchange). Both groups received normal supportive care and were followed up periodically for a year. Overall the treated group showed a slight but not significant benefit (p greater than 0.05); at two weeks' follow-up of patients admitted to the trial within 14 days of onset of neuropathic symptoms, p = 0.07. These results do not provide grounds for recommending plasma exchange for the treatment of severe AIP.

Acute Disease↗
PubMed1984

"Therapeutic" serum concentration of phenytoin: the influence of seizure type.

Serum phenytoin concentrations were monitored prospectively in 26 patients with previously untreated partial epilepsy, during monotherapy with phenytoin. Only six remained entirely seizure-free, although only four experienced further tonic-clonic seizures. There was no correlation between serum phenytoin concentrations and freedom from partial seizures in those patients in whom such seizures recurred. There did appear to be a correlation between serum phenytoin concentration and freedom from tonic-clonic seizures.

Adolescent↗
PubMed1983

Plasma concentrations of sodium valproate: their clinical value.

Plasma valproate concentrations were monitored prospectively in 54 previously untreated adult patients with epilepsy. Dose and plasma concentration were highly correlated. Adverse effects were common in association with plasma levels above 100 micrograms/ml. In patients suffering tonic-clonic seizures without focal symptoms, no seizures occurred when plasma levels were higher than 50 micrograms/ml. In patients with partial seizures, it was difficult to define a lower limit to a therapeutic range.

Clinical Trials as Topic↗
PubMed1982

A comparison of phenytoin and valproate in previously untreated adult epileptic patients.

Eighty-eight patients with the onset of epilepsy in adult life were randomly allocated to treatment with sodium valproate (600 mg/day), or phenytoin (300 mg/day), and followed up for at least 12 months. Both drugs were highly effective in the control of tonic-clonic seizures, irrespective of whether they were accompanied by focal features, but were markedly less effective in the control of partial seizures. Two patients exhibited acute allergic reactions to phenytoin. No significant differences have yet emerged in the efficacy of the two drugs, and valproate may be considered as a "fist-line" anticonvulsant in the treatment of adult onset epilepsy.

Adolescent↗
PubMed1982

Measles virus and subacute neurological disease: an unusual presentation of measles inclusion body encephalitis.

A 20-year-old girl developed a subacute neurological illness characterized by seizures and epilepsia partialis continua, which resulted in her death within 10 weeks of her first symptom. Although she had a history of unusual reactions to viral infections, there was no evidence of any underlying disorder resulting in immunosuppression. Histopathology demonstrated the presence of dense infection with measles virus. The unusual clinical features of this cases suggest that measles virus may be responsible for a wide spectrum of neurological disease ranging from measles inclusion body encephalitis on the one hand to subacute sclerosing panencephalitis on the other.

Adult↗
PubMed1980

Meningitis caused by Candida tropicalis.

Meningeal infection with Candida remains rare. We report its occurrence in a healthy man following mastoid exploration for chronic suppurative middle ear disease. The infective agent proved to be C tropicalis, which has only been isolated from CSF in two previous cases of Candida meningitis.

Candida↗
PubMed1979

Acute intoxication with sodium valproate.

Two epileptic patients developed an acute toxic encephalopathy consisting of altered behavior, deteriorating seizure control, and confusion while taking sodium valproate alone. Serum valproate levels were greater than 100 microgram/ml in both. Toxic symptoms resolved when the dose of valproate was reduced, with a consequent fall in serum concentration of the drug.

Acute Disease↗
PubMed1975

Visual evoked responses in the diagnosis and management of patients suspected of multiple sclerosis.

Averaged visual evoked responses to pattern reversal stimuli have been recorded in 54 control subjects, 51 patients with multiple sclerosis, and 55 patients with other neurological diseases which might involve the visual apparatus. The latency to the peak of the major positive potential in normal subjects under the age of 60 was 104 msec or less (mean 90-5 msec+3 SD). The latency of the VER was prolonged above this value in one or both eyes in 67 per cent of the patients with multiple sclerosis (in 84 per cent of those with definite multiple sclerosis, in 83 per cent of those with probable multiple sclerosis, and in 21 per cent of those with possible multiple sclerosis). The latency of the VER was also prolonged in 25 percent of those with an acute spinal cord lesion of unknown cause; in 46 per cent of those with an isolated brain-stem lesion unknown cause; and in 49 per cent of patients presenting with a progressive spastic paraparesis. The extra delay in latency varied from a few msec to as much as a 100 msec. In patients with multiple sclerosis, a delayed VER was found in the affected eye in all with a previous history of optic neuritis, and in 47 per cent of those with no such history....

Adolescent↗
PubMedDate not supplied

GABA and amino acid concentrations in lumbar CSF in patients with treated and untreated epilepsy.

Lumbar free CSF GABA and amino acid concentrations were measured in 43 patients with newly diagnosed untreated epilepsy and 26 patients with chronic drug-resistant epilepsy. The results were compared with those from 51 control patients. No differences in free CSF GABA concentration could be detected between patients with epilepsy, either treated or untreated, and controls. Untreated patients with primary generalised epilepsy and partial seizures had similar free CSF GABA concentrations. These results would not support the hypothesis that patients with epilepsy have a global disturbance of GABA function. CSF taurine, asparagine, aspartate, glycine and alanine were significantly reduced in patients with epilepsy compared to the control population.

Adolescent↗
PubMedDate not supplied

Cerebral arteriovenous malformations and epilepsy: factors in the development of epilepsy.

Sixty-one patients of a population of 343 with cerebral arteriovenous malformations (AVMs) were diagnosed with seizures. Their AVMs were larger (p less than 0.02) and more frequently superficial (p less than 0.05) as compared with the AVMs of patients who were diagnosed with haemorrhage. The factors influencing the development of denovo seizures in patients with diagnosed AVMs were surgical treatment, a presentation with haemorrhage, and age at diagnosis.

Cerebral Hemorrhage↗
PubMedDate not supplied

Outcomes of add-on treatment with lamotrigine in partial epilepsy.

The need for new antiepileptic drugs (AEDs) and more sensitive methods of assessing their efficacy is well recognized. This study was designed to evaluate the efficacy and safety of lamotrigine (LTG), a potential new AED and to develop and test new outcome measures. A health-related quality of life (HRQL) model was developed which contains previously validated measures of anxiety, depression, happiness, overall mood, self-esteem, and mastery and a specifically designed seizure severity scale with patient- and caregiver-based components. This HRQL model was used in a randomized, placebo-controlled, double-blind, cross-over study of LTG in 81 patients with refractory partial seizures. Seizure frequency was the primary measure and seizure severity and the HRQL were secondary measures of efficacy. The reduction in seizure frequency with LTG, relative to placebo, was 29.7% [95% confidence interval (CI) 17.8%, 39.9%] for total seizure count, 33.4% (95% CI 14.8%, 47.9%) for complex partial seizures (CPS) and 20.3% (95% CI 0.3%, 36.2%) for secondarily generalized tonic-clonic seizures (GTCS). However, although 41 patients elected to continue with LTG, only 11 experienced at least 50% reduction in total seizures, indicating that other factors influenced their decision. The score with LTG, relative to placebo, was significantly lower for the ictal (p = 0.017) and caregivers (p = 0.035) subscales of the seizure severity scale and significantly higher for happiness (p = 0.003) and mastery (p = 0.003). Simple correlation and multiple-regression analyses indicate that the effects on seizure frequency, seizure severity, and psychological variables appear to be independent of each other. This study indicates that LTG is effective in reducing seizure frequency and has additional favorable effects on seizure severity, mood, and perceived internal control. Some of the scales used indicate the potential of secondary measures of efficacy to enhance the sensitivity of trials of new AEDs.

Adolescent↗
PubMedDate not supplied

Development of a novel scale to assess life fulfillment as part of the further refinement of a quality-of-life model for epilepsy.

We have been involved in developing a health-related quality-of-life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfillment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinski's approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfillment scale has been shown to be reliable (alpha = 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health-related quality-of-life model.

Adolescent↗