Biomedical subjects
Publications and source records attributed to N Senanayake.
Five cases are reported of tuberculous patients who presented with hemiplegia as the initial symptom of their illness. In three patients the paralysis improved rapidly and completely with institution of antituberculous treatment. One case which came to necropsy revealed that the cause of the hemiplegia was a tuberculoma situated in the internal capsule.
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A quantitative assessment of post-ischaemic paraesthesiae has been made in 50 diabetic subjects and in a group of healthy age-matched controls. The results show a highly significant diminution of the paraesthetic response in the diabetic subjects. The degree of depression of the paraesthetic response was associated with the duration of the disease and the severity of the metabolic abnormality as determined by the degree of insulin dependence. Diabetics with the juvenile onset type of the disease were more adversely affected than those with the maturity onset type. There was no consistent relationship between the degree of depression of the paraesthesiae and the presence of peripheral neuropathy. The significance of these results is discussed in relation to the factors which determine the composition of the ionic micro-environment of myelinated nerve and the level of electrical excitability of the nerve fibre.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two Sri Lankan girls who, in their childhood, developed self-induced epilepsy are reported. The seizures were tonic-clonic and induced by rubbing the forehead in one case and by waving one hand in front of the eyes in the other. These manoeuvres performed while gazing at a bright light evoked generalised polyspike and wave discharges. The patients had no explanation for their behaviour but the most likely basis for the act was attention-seeking. One patient whose seizures were not controlled with phenytoin received clobazam as adjuvant therapy and showed a marked improvement clinically and electroencephalographically.
Three patients whose epileptic seizures are precipitated by arithmetic calculations are reported and their clinical and EEG features analysed along with those of 7 previous cases. The seizure disorder, in general, was characterised by an onset, in adolescence, of myoclonic jerks with or without tonic-clonic seizures and generalised bisynchronous 2-5 Hz spike-and-wave discharges in the EEG. Problems involving processing of spatial information were among the tasks which induced the dysrhythmia. The specificity and the consistency of the seizure-provoking stimuli suggest that in these patients the cortical areas responsible for calculations and related functions are abnormally hyperexcitable and the repeated stimulation during cognitive activities triggers seizure discharges. Two or our patients responded well to clobazam during a follow-up period of 6 months.
One hundred and fifty patients with eating seizures were detected over a 9 year period in two hospital clinics in Sri Lanka. The clinical and EEG features of 120 of them are compared to a control group of 120 patients with epilepsy. Patients with eating seizures showed a male predominance of 3:1. In more than 50% the onset of epilepsy was in the 2nd decade of life. A family history of epilepsy was obtained in 28.3% and 21 siblings themselves had eating seizures. The seizure type was simple or complex partial, secondarily generalised seizures were common. The EEG in 71.6% showed spikes, sharp/slow waves, focal in the temporal areas. The response to medication of eating seizures was similar to that of controls. Clobazam used in 17 patients as monotherapy or adjuvant therapy proved useful. The very high prevalence of eating epilepsy in the present series could pathogenically be related to genetic or ethnic factors and to the bulky meals rich in carbohydrates consumed by the patients.
Three Asian patients, since adolescence, had myoclonic jerks and tonic-clonic seizures during card games, draughts, and a local game "punchi." Interictal EEG showed generalized bisynchronous atypical 3-Hz spike and wave discharges. Test procedures evoked EEG dysrhythmia and clinical seizures in two patients. These patients and previously reported cases have the seizure disorder juvenile myoclonic epilepsy (impulsive petit mal), which seems particularly sensitive to provocation by cognitive functions, especially decision making. Myoclonic epilepsy is considered resistant to antiepileptic drugs other than clonazepam and valproate, but two of our patients responded well to clobazam.
The 1981 International Classification of Epileptic Seizures (ICES) was used to study the distribution of seizure types in 1,250 patients attending an Epilepsy Clinic in Sri Lanka. Based on seizure symptomatology 94.6% of the cases could be classified, and by adding the routine interictal EEG findings the percentage of classifiable seizures increased to 97%. Partial seizures (73.8% cases) were three times as common as generalized seizures (23.3% cases). Of the partial seizures, simple partial seizures (SPS) accounted for only 0.4% cases, and complex partial seizures (CPS) for 8.8%, whereas partial seizures secondarily generalized (PSGS) accounted for 64.6%. PSGS had simple onset in 12.5% and complex onset in 34.8% of cases. Myoclonic seizures were the commonest of the generalized seizures, accounting for 14.6% of all cases. Tonic-clonic seizures accounted for 7.4% of cases; absence seizures accounted for only 1.3%. The study showed the 1981 ICES to be relevant and applicable in a clinical setting with limited investigatory facilities. Difficulties encountered with regard to certain subcategories could be overcome with minor modifications which made the classification operative. Routine EEG confirmed the diagnosis in a significant number of cases but changed the diagnosis in only a few, confirming that a good standardized questionnaire is the key instrument for classifying epileptic seizures.