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Biomedical subjects

J M Freeman

Publications and source records attributed to J M Freeman.

At least 73 records · Page 4Linked to original sources
PubMed1987

A clinical approach to the child with seizures and epilepsy.

Generalized tonic-clonic seizures in children may have different causes and a different natural history than seizures and epilepsy in adults. The effects of medication may also be of greater importance during childhood. In making decisions about whether or not to treat a child who has had only one or a few seizures, the physician must consider the chance of further seizures and the possible consequences of further seizures. Since the major consequence of seizure recurrence is psychosocial, and since the psychosocial consequences of infrequent seizure recurrence vary with age during childhood and differ from those in adults, decisions about therapy should take these differences into account. The potential effects of anticonvulsants on learning and behavior should also be considered. Seizures should not be treated just "because they are there," but rather only when the risks and consequences outweight the benefits of being free of medication and its effects.

Child↗
PubMed1987

Dandy-Walker syndrome revisited.

The Dandy-Walker syndrome is said to be associated with a high incidence of mental retardation and motor dysfunction leading some to suggest termination of the affected fetus in utero. Since this view seemed contrary to our experience, we reviewed 19 patients with the Dandy-Walker syndrome diagnosed from 1966 to 1983. Thirteen patients with Dandy-Walker syndrome were diagnosed before 6 months of age and followed for more than 2 years (mean: 10 years). In the absence of other associated major abnormalities, 7 of 8 (88%) are functioning well and have attended regular schools. Two of these seven have had special help with isolated learning problems. None of these patients have significant motor disability. One additional patient with normal intellectual and motor function died of acute shunt malfunction. In the remaining 4 patients with Dandy-Walker-associated abnormalities, 3 (75%) have severe intellectual retardation and spastic cerebral palsy. Five of six patients (83%) with Dandy-Walker syndrome diagnosed after 6 months of age are normal. The outcome of patients with Dandy-Walker syndrome appears far better than previously reported.

Adolescent↗
PubMed1987

Psychologic and behavioral effects of antiepileptic drugs in children: a double-blind comparison between phenobarbital and valproic acid.

Traditional clinical monitoring of children with epilepsy does not appear to be sufficiently sensitive to cognitive functioning and behavioral problems. Although subtle, these changes may alter a child's ability to perform well in school and in society. Physicians must prevent seizures without producing intolerable side effects, and ways of more appropriately assessing these side effects must be developed. In this double-blind, counter-balanced, crossover study of 21 children, the effects of phenobarbital and valproic acid on cognitive functioning and behavior were measured. There was no difference in seizure control between the drugs, and each medication was maintained in the therapeutic range for 6 months (mean phenobarbital level, 21.2 micrograms/mL; mean valproic acid level, 94.1 micrograms/mL). Children were treated with each drug for 6 months. Differences between the drugs were seen on measurements of cognitive function and behavior. On four tests of neuropsychologic function, children performed significantly less well while receiving phenobarbital (P less than .01). There was no evidence that the patients were sedated or less able to perform continuous performance tasks while receiving phenobarbital. Parental assessment of behavior indicated significantly worse behavior with the phenobarbital regimen for three items (P less than .01) and children were measurably more "hyperactive" (P less than .05). Routine clinical assessment of the patients did not reveal differences between the drugs with respect to routine laboratory measurements or side effects as assessed by history or physical examination. Although children may appear to tolerate a medication without clinically apparent problems, subtle but significant changes in intellectual function and behavior may be occurring. Additional, more sensitive, methods of monitoring patients while receiving these drugs is necessary.

Adolescent↗
PubMed1987

Benign epilepsy of childhood: a speculation and its ramifications.

Most children with generalized tonic-clonic seizures have a benign developmental disorder of seizure threshold that will be outgrown with or without treatment. Such children may have one or more infrequent seizures before adequate threshold is achieved. A small percentage of children will have frequent generalized seizures (epilepsy) due to brain damage or abnormality. Such patients require vigorous anticonvulsant therapy. However, for the children with "benign childhood epilepsy" treatment may be worse than the disease.

Anticonvulsants↗
PubMed1987

Conversion reactions in children as body language: a combined child psychiatry/neurology team approach to the management of functional neurologic disorders in children.

Conversion reactions in children represent a form of "body language," a plea for help in a child who has no alternative method of communicating stress. Although conversion reaction may take many forms, this report focuses on those presenting as neurologic dysfunction. The parallel evaluation and treatment of these symptoms by a child psychiatry/pediatric neurology team has demonstrated success in removing the symptom while simultaneously evaluating the underlying stress. Unnecessary medical tests have been avoided and perpetuating factors have been eliminated. Continued family treatment has emphasized health rather than disease and seems to have prevented recurrence.

Adolescent↗
PubMed1986

Making decisions for the severely handicapped newborn.

Standard ethical approaches to decision-making which are based on rights, duties, obligations, beneficence, or best interests often seem inadequate or insufficient when applied to the individual infant, as in the case of Baby Jane Doe. A process approach which takes account of moral theory, but which allows tolerance, within limits, for a possible range of decisions, would appear to offer more reasonable decisions. However, any decision must be based on good facts and accurate prognosis. Pending the availability of medical records on Baby Jane Doe, judgment of the decisions made at Stony Brook must be suspended.

Abnormalities, Multiple↗
PubMed1986

The precision of pathway selection by developing peripheral axons in the axolotl.

At the time of hindlimb development in the axolotl there is a well-established but still developing trunk innervation. The trunk innervation is primarily composed of the segmental nerves, each of which consists of a dorsal and a ventral ramus and its branches. At a few segmental levels in the region of the hindlimb a large number of additional axons arise to innervate the limb. To reach the limb, they must grow via the ventral rather than the dorsal rami. The precision with which this pathway is selected was determined by counting axons in the dorsal and ventral rami at limb segmental levels, prior to and during the period of maximum axon proliferation. If outgrowth is highly directed rather than random, then the ratio of ventral/dorsal ramus axons should increase significantly during the period when large numbers of additional axons are produced. In addition, since the dorsal trunk varies little in size between limb segments and immediately caudal 'non-limb' segments, the number of axons in the dorsal rami can be compared at the two levels. Mistaken projections should result in inordinately large axon numbers in dorsal rami at limb compared to non-limb levels. The results show that there is approximately a tenfold increase in the ratio of ventral/dorsal ramus axons at the time of maximum outgrowth to the limb, thus the mode of distribution at the ventral-dorsal branch point is significantly altered in favour of growth toward the limb, and outgrowth appears to be highly directed rather than random. Moreover at this time there is no discernible increase in the number of dorsal ramus axons at limb levels while those at non-limb levels increase fourfold. The apparent growth of all axons into the ventral ramus suggests the presence of a strong, non-specific attraction.

Ambystoma mexicanum↗
PubMed1985

Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. A prospective study.

Antiepileptic medications were discontinued in 88 children with epilepsy of various causes who had been free of seizures for two to four years. The subjects were then followed for six months to five years (mean, 22 months). Sixty-six (75 per cent) remained free of seizures. Electroencephalographic characteristics, type of seizure, and age at onset were important in predicting outcome. Specific electroencephalographic features (such as the presence or absence of slowing or spikes) were more predictive than simple classification of an electroencephalogram as normal or abnormal. A history of complex partial seizures that had been controlled for two years carried a relatively favorable prognosis (P less than 0.05), whereas a history of atypical febrile seizures carried a poor prognosis (P less than 0.05). The variable of a younger age at onset was also associated with a better outcome (P less than 0.05), but only if accompanied by electroencephalographic slowing. Altogether, six variables (the interaction of age at onset with electroencephalographic slowing, electroencephalographic spikes, atypical febrile seizures, complex partial seizures, electroencephalographic slowing, and electroencephalographic change) were statistically significant (P less than 0.05) in predicting outcome. We conclude that in most children with epilepsy who have been free of seizures for two or more years, antiepileptic medications can safely be discontinued, and that it is possible to predict reasonably well which children will remain free of seizures.

Adolescent↗
PubMed1985

Management of hydrocephalus in infancy: use of acetazolamide and furosemide to avoid cerebrospinal fluid shunts.

Despite its effectiveness, cerebrospinal shunting for hydrocephalus continues to be accompanied by considerable complications and morbidity. Medical therapy with acetazolamide 100 mg/kg/day and furosemide 1 mg/kg/day can be an effective alternative to shunting by halting progression of hydrocephalus until such time as sutures can become fibrosed and spontaneous arrest can occur. In an appropriately selected population older than 2 weeks with hydrocephalus of varied origin, our success rate in avoiding shunting is greater than 50%. The dramatic difference between the number of hospitalizations of patients with shunts and those treated medically, and the potential to avoid shunt dependence would appear to make an initial trial with medical therapy worthwhile.

Acetazolamide↗
PubMed1985

Intraocular penetration of systemically administered antifungal agents.

Amphotericin B, 5-flucytosine (5-FC), and ketoconazole levels were estimated in vitreous and aqueous samples taken from four patients undergoing therapeutic vitrectomy for fungal endophthalmitis. The levels of amphotericin B in the vitreous of three patients were low (.04 - .17 microgram/ml). However, 5-FC was present in a concentration of 22.2 micrograms/ml in one patient. In another case the aqueous level of ketoconazole was 0.35 microgram/ml. The vitreous in the same patient contained 0.71 microgram/ml of the drug.

Amphotericin B↗