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Biomedical subjects

O Devinsky

Publications and source records attributed to O Devinsky.

At least 145 records · Page 8Linked to original sources
PubMed1988

J. Russell Reynolds and the study of interictal symptoms in epilepsy.

Sir John Russell Reynolds (1828-1896) was a prominent English neurologist who was among the first to carefully study interictal behavior in patients with epilepsy. He challenged the prevailing dogma that severe mental illness was nearly always concomitant of epilepsy. Studying the cognitive and emotional functions of 62 patients with essential (idiopathic) epilepsy, he found that 39% of the patients were normal, 32% had only mild impairment of recent memory, and 29% had moderate to severe psychopathologic findings. His study of interictal behavior in epilepsy is one of the earliest attempts to avoid selection bias and represents an important contribution to the study of this problem.

England↗
PubMed1988

Clinical and neuropathological findings in systemic lupus erythematosus: the role of vasculitis, heart emboli, and thrombotic thrombocytopenic purpura.

We reviewed the medical records and autopsy reports of 50 patients with systemic lupus erythematosus to determine the clinical and neuropathological features of this disease. Neuropsychiatric disturbances were found in the majority (74%) of the patients, occurring as psychiatric illness only (5 patients), neurological disorders only (15 patients), and both together (17 patients). Central nervous system (CNS) lesions were present in half the patients; embolic brain infarcts (10 patients) and CNS infections (8 patients) were the most common. Cardiac sources of emboli were Libman-Sacks endocarditis (5 patients), chronic valvulitis (2 patients), and left side of heart mural thrombus (2 patients). There was no evidence of active CNS vasculitis. Clinical features of thrombotic thrombocytopenic purpura (TTP) developed during the terminal illness in 14 patients, 7 of whom also had pathological evidence of TTP. Correlation between neuropsychiatric disorders and brain lesions could be made in approximately half the patients. This study indicates that cardiac emboli from Libman-Sacks endocarditis and TTP are common pathogenetic factors of CNS disease in systemic lupus erythematosus, whereas CNS vasculitis is rare.

Adolescent↗
PubMed1988

Cerebrospinal fluid pleocytosis following simple, complex partial, and generalized tonic-clonic seizures.

We observed postictal pleocytosis in 7 of 62 cerebrospinal fluid specimens obtained from 27 patients with epilepsy. Each patient had a known seizure disorder; none had any other cause for the pleocytosis. The maximum number of leukocytes was 12/mm3; the maximum number of erythrocytes was 190/mm3. Postictal pleocytosis was more common in samples obtained within 12 hours of the last seizure. Although previous studies have emphasized that pleocytosis is more common after repetitive generalized tonic-clonic seizures, we found increased leukocyte counts in cerebrospinal fluid after single simple, complex partial, or generalized tonic-clonic seizures.

Adolescent↗
PubMed1988

Clinical and electroencephalographic features of simple partial seizures.

The clinical and electroencephalographic features of 87 simple partial seizures in 14 patients were studied with video-EEG telemetry. The patients were able to respond to verbal stimuli during all seizures and, later, could clearly recall ictal events. To determine whether the EEG changes in simple partial seizures could be reliably observed, a reader blindly reviewed four EEGs of equal duration for each seizure. These EEGs consisted of one ictal and three nonictal recordings obtained at predetermined times before the seizure. There were 27 motor seizures (mean duration, 86 seconds; range, 2 to 250 seconds), all involving clonic movements of the head and/or upper extremities; 8 (30%) of these had a sensory component (pain in 6, paresthesia in 2). An EEG change, usually localized spikes or sharp waves over the contralateral or both rolandic regions, was identifiable in nine (33%) of the motor seizures. The 60 nonmotor seizures (mean duration, 63 seconds; range, 8 to 375 seconds) involved a variety of symptoms, including somatosensory/special sensory (3 seizures), autonomic (26 seizures), cognitive (1 seizure), affective (14 seizures), and mixed, or more than one category of nonmotor symptoms (16 seizures). In only nine (15%) of the nonmotor seizures was there an ictal EEG change, usually localized spikes or paroxysmal theta activity over the temporal region. Overall, among the 87 simple partial seizures, only 18 (21%) revealed ictal EEG changes. Thus, a normal EEG is common during simple partial seizures and does not exclude the diagnosis.

Adolescent↗
PubMed1987

Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study.

We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A trial of high-dose bromocriptine did not stimulate purposeful verbal or motor activity. Fluorine 18-fluorodeoxyglucose/positron emission tomographic studies, performed before and during bromocriptine therapy, demonstrated cerebral hypometabolism and treatment-related decreases in regional cerebral blood volume. We conclude that whole-brain or total-body irradiation may increase blood-brain barrier permeability to polyene antibiotics, and that high-dose therapy with dopamine agonists is unlikely to benefit patients with akinetic mutism due to diffuse white-matter lesions.

Adult↗
PubMed1987

Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: an autopsy study of 30 cases and a review of the literature.

The pathology of cytomegalovirus (CMV) encephalitis was studied at autopsy in thirty patients with acquired immunodeficiency syndrome. Lesions could be segregated into five major categories: microglial nodules, isolated inclusion-bearing cells, focal parenchymal necrosis, necrotizing ventriculo-encephalitis, and necrotizing radiculo-myelitis. Microglial nodules and CMV inclusions were present in all brains. Microglial nodules were found with variable frequency and had greatest density in subcortical grey matter. Only a small percentage (average, 6.5 per cent) contained CMV inclusion-bearing cells. Isolated inclusion-bearing cells unaccompanied by microglial nodules or inflammatory infiltrates were seen in half the patients. CMV inclusions were identified in capillary endothelia, astrocytes, and neurons. Focal CMV necrosis, ventriculo-encephalitis, and radiculo-myelitis were less frequent. The presence of CMV inclusions in capillary endothelia suggests a vascular portal of entry for the virus into the central nervous system. The diffuse ependymal and/or subpial distribution of CMV in several patients suggests additional dissemination via the cerebrospinal fluid. Isolated inclusion-bearing cells may reflect the relative nonpermissiveness of surrounding central nervous system parenchyma for CMV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Cardiac manifestations of complex partial seizures.

Six patients with complex partial seizures in whom the first or most prominent manifestation was cardiovascular are described. "Anginal pain," which was usually atypical, developed in five patients (mean age 34), although three were admitted to coronary care units; sinus tachycardia developed in one, sinus bradycardia leading to syncope developed in one, and a cluster of symptoms suggestive of pheochromocytoma developed in one. The causal relationship between complex partial seizures and these symptoms is based on clinical history, electrodiagnostic studies indicating epilepsy (in five of six cases) without changes of myocardial ischemia, and response to anticonvulsant but not antianginal medications. Complex partial seizures that present with cardiovascular and other visceral symptoms represent an underdiagnosed, treatable disorder.

Adult↗
PubMed1986

Delayed intracerebral hemorrhage after ventriculoperitoneal shunting.

A rare complication of ventriculoperitoneal shunting is presented. In this case, a moderate-sized intracerebral hemorrhage (3 to 5 cm in maximal diameter) occurred 1 week after operation for idiopathic hydrocephalus in a 43-year-old woman. The patient recovered fully without operative intervention. No other case of delayed intracerebral hemorrhage after a ventricular shunting procedure was found in a review of the literature. The presumed mechanism in the present case is delayed erosion of a cerebral blood vessel by the ventricular catheter.

Adult↗
PubMed1984

Varieties of aggressive behavior in temporal lobe epilepsy.

While an increase in aggression has frequently been reported in association with temporal lobe epilepsy, the validity of this behavioral observation and the relationship of specific aggressive behavior to electrophysiologic abnormality in the human limbic system remain unclear. Case reports of five patients document the clinical importance of aggressive behavior, especially during the interictal period, in patients with temporal lobe epilepsy. Aggressiveness was often encountered together with other deepened emotions and changes in behavior previously described as an interictal behavior syndrome. Variations among the individual patients may clarify the neuroanatomical mechanisms leading to aggression and suggest specific therapeutic interventions.

Adult↗
PubMed1983

Neuroanatomy of Gilles de la Tourette's syndrome. Possible midbrain involvement.

Alterations of the dopaminergic system are well documented in Gilles de la Tourette's syndrome (TS). Dopamine (DA)-receptor blockers often relieve symptoms, whereas DA agonists acutely exacerbate them. The cluster of symptoms and known localization of lesions in encephalitis lethargica (EL), together with studies on the anatomy of vocalization, suggest that damage to the periaqueductal gray and midbrain tegmentum may be involved in TS. Pharmacologic findings in patients with TS and EL suggest that oculogyric crises and obsessions are associated with diminished DA levels and the development of supersensitive DA receptors, and that tics occur when these receptors are stimulated.

Adolescent↗
PubMed1983

Seizures after convulsive therapy: a retrospective case survey.

We reviewed all documented cases of spontaneous seizures that followed convulsive therapy. Nineteen studies provided information in 81 cases. The average annual incidence of spontaneous seizures was 114 per 100,000, 5 times more frequent than an age-adjusted nonpsychiatric cohort. Host susceptibility rather than treatment features influenced seizure development. A longer latency to first seizure was associated with greater likelihood of seizure recurrence, a relationship also observed in posttraumatic epilepsy.

Adolescent↗
PubMed1982

Embarrassment as the aura of a complex partial seizure.

A man with a grade II astrocytoma in the medial frontal lobe exhibited complex partial seizures, with the aura being a feeling of extreme embarrassment. This previously unreported ictus suggests that an electric discharge in the prefrontal cortex may produce the opposite effect of prefrontal lesions, in which there is a lack of insight and an absence of the capacity for embarrassment.

Adult↗
PubMed1977

Enhancing effect of low dose cyclophosphamide treatment on the in vitro antibody response.

We have studied the effect of cyclophosphamide (CY) administration on the subsequent in vitro antibody response in the mouse. Treatment with a low dose (20 mg/kg) of CY four days before culture results in an increased IgM response to the T-independent antigen trinitrophenylated polyacrylamide (TNP-PAA), without affecting the background response of unstimulated cultures. This suggests that CY treatment eliminates a short-lived suppressor cell, involved in the regulation of the in vitro B cell response. In contrast, the same regimen decreases the ability of nude mouse spleen cells to respond to TNP-PAA, showing that the target of CY-enhancing effect is a mature T cell. The increased response observed in conventional mice should be the result of a balance between the direct suppressive effect of CY on B cells and the elimination of a suppresor T cell, the latter phenomenon being of predominant significance in our conditions. The target of CY-enhancing effect is nonadherent to plastic, but adherent to Sephadex G-10 columns.

Acrylamides↗
PubMed1976

Cell-mediated immunity: delayed-type hypersensitivity and cytotoxic responses are mediated by different T-cell subclasses.

Cell-mediated immunity includes both the generation of cytotoxic cells and initiation of delayed-type hypersensitivity (DTH). The resting T-cell population, before stimulation by antigen, already contains cells of the Lyl subclass that are programmed to initiate DTH (and helper function) but not cytotoxic responses, as well as Ly23 cells which can generate killer activity (and suppressive function) but not DTH. The central implication of these findings is that the broad division between humoral and cell-mediated immune responses does not precisely correspond to the division of labor among T-cell subclasses. The relative contribution of DTH-competent Lyl cells and cytotoxic Ly23 cells to the classical homograft response remains to be determined.

Animals↗
PubMedDate not supplied

Brief report: Adolescents' attitudes toward epilepsy: further validation of the Child Attitude Toward Illness Scale (CATIS).

OBJECTIVE: To examine adolescents' attitudes toward having epilepsy using the Child Attitude Toward Illness Scale (CATIS) and to provide further psychometric validation of the scale in this population. METHODS: Participants were 197 adolescents aged 11 to 17 years who completed the CATIS at two points and two external validation scales. Test-retest and internal consistency reliability and construct validity were computed. Analysis of variance was used to examine differences in attitudes according to gender, age, and epilepsy severity. RESULTS: Girls, older adolescents, and those with more severe epilepsy had more negative attitudes toward having epilepsy than boys, younger adolescents, and those with moderate or mild epilepsy, respectively. Psychometric analyses yielded excellent internal consistency reliability and good test-retest reliability. The CATIS was moderately correlated with self-esteem and mastery, supporting its construct validity. CONCLUSIONS: The CATIS is a useful and psychometrically sound tool to assess adolescents' attitudes toward having chronic illness.

Adolescent↗