Muscular inhibitory and excitatory phenomena during spike-and-wave discharges: effect of posture.
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Biomedical subjects
Publications and source records attributed to E Lugaresi.
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This paper presents a case of epileptic seizures occurring during card games and draughts. The patient was a 26-year-old man who complained of "arrests of thought" while playing cards or draughts or solving mathematical problems. The attacks, which were very rare in other situations, had begun at the age of 14. Between the ages of 14 and 21 he had had occasional tonic-clonic seizures. Protracted EEG recording showed bursts of 3 Hz spike-wave discharges during the day. Such discharges were very much more frequent when the patient was playing cards of draughts and only these circumstances were subjectively experienced as lapses of consciousness. Various explanations can be advanced for this case.
The present report documents for the first time the polygraphic pattern of an ecstatic seizure and confirms that this kind of seizure may be an expression of a temporal lobe epilepsy.
3 cases are reported, where neuralgic amyotrophy occurred simultaneously in 3 members of one family, living in the same household. Despite the familial occurrence and the simultaneous onset, the clinical pictures were those of the common form of the neuralgic amyotrophy.
A case of polyneuropathy in a 14-year-old boy, a chronic gasoline sniffer, is reported. Clinical and electromyographic examination showed a symmetrical motor involvement, mainly distally and in the lower limbs. A sural nerve biopsy showed only slight changes, both of axonal and demyelinating type. The role of gasoline toxic substances in the etiology of this rare polyneuropathy is discussed.
Patients suffering from Pickwickian syndrome or primary hypoventilation syndrome present apneas of a predominantly obstructive type which follow one another without interruptions throughout the duration of sleep. It is not possible to ascribe the somnolence of these patients to carbonarcosis, because in most cases Pa CO2, though high during sleep, presents normal values or slightly higher than normal values during wakefulness. Obstructive apneas are the cause of this syndrome: the elimination of obstructive apneas by means of tracheostomy leads to a complete clinical recovery. Before they began to suffer from hypersomnia, all these patients had been snoring heavily for many years. Snoring is therefore a fixed stage in the evolution of this disease. The fact that the overall clinical and polygraphic characteristics of these syndromes are identical suggests that they all constitute a single nosographic entity, which we have called "hypersomnia with periodic apneas".
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A case of stiff-man syndrome associated with primary generalised epilepsy is reported. In addition, nocturnal polygraphic recording revealed a nocturnal myoclonus. Detailed examination of the central nervous system did not show specific changes. There is no direct proof as to a spinal or supraspinal origin of the stiff-man syndrome. The absence of specific anatomical lesions may indicate a functional rather than a structural disturbance in its physiopathogenesis.
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A case of phenytoin (DPH) encephalopathy with increasing seizures and EEG and mental changes is described. Despite adequate oral dosage of DPH (5 mg/kg/daily) the plasma level was very low (2.8 microgramg/ml). The encephalopathy was probably an idiosyncratic and not toxic or allergic reaction. In fact the concentration of free DPH was normal, the patient presented a retarded morbilliform rash during DPH treatment, the protidogram was normal, and an intradermic DPH injection had no local effect. The authors conclude that in a patient starting DPH treatment an unexpected increase in seizures, with EEG and mental changes occurring simultaneously, should alert the physician to the possible need for eliminating DPH from the therapeutic regimen, even if plasma concentrations are low.
The case of a mentally retarded 18-year-old girl who for 2 years has experienced epileptic seizures exclusively during meals is discussed. Polygraphic recordings have defined the electrical and clinical features of these seizures. None of the possible precipitating factors considered in other cases in the literature (chewing, swallowing, conditioned reflex, etc.) seems to be involved in this case. We hypothesize that in our patient the precipitating factor is the complete act of eating a meal, which involves the satisfaction of a basic drive.
We describe a syndrome characterized by acquired micrognathia, hypersomnia, and periodic apneas during sleep. Six patients affected with the syndrome underwent nocturnal and diurnal polygraphic recordings that demonstrated that during sleep there is an uninterrupted succession of apneas, primarily the obstructive type, analogous to those observed in Pickwickian syndrome. Simultaneous recording of pulmonary and systemic arterial pressure during sleep and repeated blood gas analyses have shown that as soon as the apneas appear there is a decisive increase in pulmonary and systemic pressure and serious alveolar hypoventilation. The hemodynamic and ventilatory changes are even more intense during rapid eye movement sleep. Tracheostomy, performed on five of our patients, is the only treatment producing complete clinical remission of the syndrome.