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Biomedical subjects

L D Blumhardt

Publications and source records attributed to L D Blumhardt.

At least 19 recordsLinked to original sources
PubMed1991

Value of a programmed investigation unit: an audit study.

A programmed investigation unit (PIU) was set up in a regional neuroscience centre. Its effects were assessed by measuring the savings associated with one particular investigation, myelography, which accounted for 50% of admissions to the PIU. Substantial savings appear to be possible, but accounting techniques allow wide variations in the estimated amounts. These benefits have to be measured against improvements which occurred simultaneously on the other wards.

Cost Control↗
PubMed1991

A double blind trial of botulinum toxin "A" in torticollis, with one year follow up.

A double blind placebo controlled crossover trial was performed of botulinum toxin "A" in 20 patients with spasmodic torticollis. There was a statistically significant benefit for those treated with toxin; 12 on toxin improved objectively, compared with four on placebo (p less than 0.04). After a follow up period of one year, 16 still seemed to benefit from repeated toxin injections. The main side effect was dysphagia, which appeared to be dose related in individual patients.

Adult↗
PubMed1989

Profiles of instant heart rate during partial seizures.

Instant heart rate (R-R intervals) can be readily studied during spontaneous seizures recorded with ambulatory cassette AEEG/AECG techniques. Ninety-three seizures were recorded in 32 patients with complex partial epilepsy. Instant R-R interval plots showed that 74% of seizures were associated with a dominant tachycardia, the most characteristic features of which were the initial steep acceleration phase at seizure onset and the wide fluctuations in heart rate ('exaggerated sinus arrhythmia') which occurred during and immediately after the seizure. Five percent of seizures were associated with a dominant but transient phase of heart rate slowing during or towards the end of the seizure. Nineteen percent of seizures showed equivocal or negative ictal effects on the heart rate and rhythm despite unequivocal AEEG seizure discharges. Conversely, other patients had characteristic heart rate changes despite equivocal AEEG abnormality. The heart rate profiles showed striking seizure-to-seizure similarities when multiple fits were recorded in the same patient. Ratemeter profiles may be clinically useful to locate epileptic seizures in long duration records; they can help to locate seizures which are either inaccurately timed or poorly identified by the event marker, or not clearly associated with definite AEEG changes. The secondary cardiac effects of epilepsy may be misdiagnosed if their primary cerebral origin is not suspected.

Adult↗
PubMed1989

Cardiac asystole associated with epileptic seizures: a case report with simultaneous EEG and ECG.

Cardiac arrhythmias occurring in association with epileptic seizures are a potential source of diagnostic confusion and a possible cause of sudden unexpected death in epilepsy. A case is described in which simultaneous ambulatory electroencephalography and electrocardiography revealed periods of asystole coinciding with epileptic seizures. The aystole appeared to precede obvious changes in the scalp recorded electroencephalogram (EEG), but clinical attacks and EEG seizure activity were not altered by pacemaker correction of the cardiac arrhythmias.

Arrhythmias, Cardiac↗
PubMed1989

A prospective audit of the use and costs of myelography in a regional neuroscience unit.

A consecutive series of 397 myelograms performed in 385 patients over a six month period at the Mersey Regional Neurosciences Unit is reported. The reasons for performing the myelogram were to identify the cause of a radicular lesion in 54% of patients, a chronic spinal cord lesion in 30%, an acute cord lesion in 9%, suspected disease at the level of the foramen magnum 6%, and for a variety of other conditions in 8%. For the 385 patients undergoing a myelogram in the study period, the median interval from admission to request, request to myelography and from myelography to discharge was nought, one and three days respectively. The proportion of patients submitted to myelography by individual consultants ranged from 7% to 28%. There was a two-fold variation in the delays in the time to requesting and performing myelograms. There was room for improvement in the clinical information supplied on the myelography request form. The role of ancillary investigations and their effect on myelography was unclear. Only 16 of the patients with suspected cord disease had visual evoked responses performed before myelography. Five of them had myelography after an abnormal result. The estimated annual direct cost of myelography in the unit was at least 486,000 pounds. Reorganisation might have yielded hypothetical "savings" of between 30,000 pounds (6%) and 155,000 pounds (32%), though in practical terms these "savings" represented resources which might have been freed for use in other higher priority clinical problems within the unit, rather than true reductions in monetary cost.

Myelography↗
PubMed1987

Magnetic resonance imaging in isolated noncompressive spinal cord syndromes.

The frequency with which patients presenting with acute or chronic noncompressive cord syndromes subsequently develop multiple sclerosis is uncertain. Magnetic resonance imaging (MRI) was performed on 121 patients with such syndromes to determine the frequency of asymptomatic brain lesions and to assess the sensitivity of MRI in detecting the local cord lesion. MRI findings were compared with those from visual, brainstem, and somatosensory evoked potentials (VEPs, BAEPs, SEPs), and cerebrospinal fluid electrophoresis. Lesions were seen in the appropriate cord region in 47 of 73 patients (64%) with a cervical syndrome, and in 7 of 25 patients (28%) with a thoracic or lumbar syndrome. MRI demonstrated more cervical lesions than did SEPs, but fewer thoracic or lumbar lesions. Cord swelling was seen in 6 patients and atrophy in 10. Of those with acute syndromes, abnormalities were seen with brain MRI in 18 of 32 patients (56%), with VEPs in 2 of 30 patients (7%), and with BAEPs in 2 of 24 patients (8%). In patients with chronic syndromes, abnormalities were seen with brain MRI in 73 of 89 patients (82%), with VEPs in 22 of 80 patients (28%), and with BAEPs in 12 of 62 patients (19%). Brain MRI was thus more sensitive than evoked potentials were in establishing multiplicity of lesions. However, in acute syndromes, it was not possible to diagnose multiple sclerosis from a single abnormal brain scan in chronic syndromes, a diagnosis of clinically probable multiple sclerosis could be made from one scan, provided there was no better explanation for the abnormalities: the added presence of oligoclonal bands allows a diagnosis of laboratory-supported, definite multiple sclerosis as was the case in 28 patients in this series.

Adolescent↗
PubMed1986

Electrocardiographic accompaniments of temporal lobe epileptic seizures.

74 spontaneous seizures in 26 patients with a clinical diagnosis of temporal lobe epilepsy (complex partial seizures) were recorded by simultaneous ambulatory cassette monitoring of the electrocardiogram and the electroencephalogram (EEG). In 24 patients (92%) seizures were associated with an increased heart rate. The maximum heart rates exceeded 120 beats/min in 67% of seizures, 140 beats/min in 30%, and 160 beats/min in 12%. The acceleration of heart rate was greater in patients under than in those over 25 years old (p less than 0.01) and in those not treated with than in those on anticonvulsant drugs (p less than 0.01). Ictal cardiac arrhythmias occurred in 42% of the patients and the commonest was an irregular series of abrupt rate changes which occurred towards the end of the EEG seizure discharge. Asymptomatic (clinically silent) arrhythmias occurred no more frequently in the patients than in age and sex matched healthy subjects. These secondary autonomic effects of epilepsy may lead to diagnostic errors if their cerebral origins are not suspected. They seem to be reduced in severity by anticonvulsant drugs (ACD) and they may account for sudden unexplained deaths in epileptics.

Adolescent↗
PubMed1985

Variable effects of pathologic scotomata on wave form of pattern-reversal visual evoked response.

Further experiments in healthy subjects have confirmed the characteristic but variable differential effect of experimental scotomata on the pattern evoked potentials. While the waveform changes associated with different pathological scotomata also showed considerable variability, certain features common to healthy and abnormal responses could be identified. These non-specific effects of scotomata on component amplitudes and distributions frequently result in spurious delays of wide-field responses and thus have important implications for the pathophysiological interpretation of abnormal responses.

Evoked Potentials, Visual↗
PubMed1978

The effect of experimental 'scotomata' on the ipsilateral and contralateral responses to pattern-reversal in one half-field.

The averaged cortical responses to a reversing checkerboard pattern presented monocularly in either left or right visual half-fields have been recorded from the occipital scalp using a transverse chain of widely spaced electrodes referred to a common mid-frontal electrode. The half-field responses showed a consistent asymmetry, the dominant feature of which was a positive wave (P100) that was widespread on the ipsilateral scalp and maximally recorded from the midline and ipsilateral electrodes. This formed part of the triphasic negative-positive-negative complex, the other two components being an N75 and an N145. On the contralateral scalp it was generally possible to record a triphasic complex of opposite polarity, but this was usually of smaller amplitude and its components (P75, N105, P135) showed greater variation in latency and morphology than the ipsilateral components. With progressive occlusion of the pattern stimulus from the central regions of the visual half-field, the ipsilateral positive wave (P100) was increasingly attenuated, while components of the contralateral complex were relatively unaffected, or, in some cases, enhanced. By contrast, reducing the radius of the stimulated area had relatively little effect on the ipsilateral P100, while the contralaterally recorded response was attenuated. These differential effects on the half-field response components are discussed in relation to the anatomy of the central and paracentral cortical representation of the visual field. The implications for the interpretation of evoked potential recordings in patients with field defects are considered.

Adolescent↗
PubMed1978

Neurological asymmetries immediately after unilateral ECT.

Twenty-nine right handed patients were examined neurologically before and immediately after each of 62 unilateral ECTs to the dominant and non-dominant hemispheres. Most convulsions were followed by signs of transitory neurological dysfunction referable to the treated hemisphere. These signs included deep tendon reflex asymmetry, hemiparesis, tactile and visual inattention, and homonymous hemianopia. After treatment to the right hemisphere some patients had left visuospatial neglect, while all patients who had dominant hemisphere ECT were transiently dysphasic. All neurological abnormalities tested resolved within 20 minutes of treatment.

Aphasia↗