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Biomedical subjects

P Thomas

Publications and source records attributed to P Thomas.

At least 163 records · Page 9Linked to original sources
PubMed2001

A prospective comparison between two seizure classifications.

The International Classification of Epileptic Seizures is the most widely used, but an alternative system based purely on ictal symptoms and signs has been proposed: the semiological classification. Our objective was to compare the two in a sample of patients evaluated at epilepsy centers. We collected 78 consecutive patients evaluated in outpatient epilepsy clinics who subsequently underwent noninvasive video-EEG monitoring at three centers. Patients with pseudoseizures were excluded. Seizures were first classified based on information obtained during clinic visits, and again after video-EEG monitoring. Each time, seizures were classified using both the International Classification and the semiological classification. Eventual epilepsy syndrome diagnosis was based on all the clinical data, video-EEG monitoring, and other independent tests including imaging studies. Sixty-six (87%) patients were classified as having 'complex partial seizures' in the International Classification. Using the semiological classification, these same 66 patients were classified as follows: automotor (34), dialeptic (17), hypermotor (13), hypomotor (2). Seizure classification changed between initial 'clinic-based' data and the 'monitoring-based' classification in 27 cases using the ILAE, vs. six using the semiological classification. Seizure classification tended to change significantly between pre- and post-monitoring using the ILAE but not the semiological classification. The term complex partial seizure included multiple categories of the semiological classification, and was very nonspecific. The semiological classification may be better suited for everyday clinic use, since it is based solely on clinical characteristics.

Electroencephalography↗
PubMed2001

Homeopathy in the USA.

Homeopathy was introduced into the USA by Hans Burch Gram in 1825. It developed largely through immigration of German homeopaths. The first homeopathic medical college was established in Allentown, PA in 1835. The American institute of Homeopathy (AIH) was founded in 1844. The American Medical Association was founded in 1847 and pursued policies hostile to homeopathy from the outset. Eclectic medicine was widespread in nineteenth century medicine, one of the greatest homeopaths, JT Kent had originally been an eclectic. The International Hahnemannian Association split from the AIH in 1880. The Flexner Report of 1910 resulted in many homeopathic medical colleges being closed down. Homeopathy in the USA was in steep decline from the 1920s to the 1960s but has had a strong recovery since the 1970s.

American Medical Association↗
PubMed2001

The use of thromboembolic deterrent stockings and a sequential compression device to prevent spinal hypotension during caesarean section.

Hypotension is a common side effect of spinal anaesthesia for caesarean section. We have performed a randomised, controlled study to determine the efficacy of a sequential compression device (SCD) (Kendall) in combination with thromboembolic deterrent (TED) stockings (Kendall) to reduce the incidence of hypotension in this setting. Within 20 min of spinal injection, there was no statistically significant difference in the incidence of hypotension (defined as less than 100 mmHg and less than 80% of baseline blood pressure) (TED/SCD group 65%, control 80%, P = 0.12). However, there was a trend for those receiving TED/SCD prophylaxis to require less ephedrine to maintain normotension than the control group (median TED/SCD 3 mg, control 6 mg, P = 0.08). The administration of ephedrine deviated from protocol on a total of 46 occasions (2.3% of recordings). To try to reduce the influence of this, we reinspected our data using time to first episode of hypotension with a Kaplan-Meier survival analysis. This showed that the instantaneous risk (hazard) of developing hypotension was 1.8 (95% CI: 1.1-2.9) times higher in controls than those receiving TED/SCD prophylaxis (P = 0.02). Despite demonstrating some benefit of TED/SCD prophylaxis to prevent hypotension, we do not consider that the magnitude of this benefit warrants their routine use.

Clinical Trial↗
PubMed2001

Early life risk factors for adult asthma: a birth cohort study of subjects at risk.

BACKGROUND: Prediction of adult asthma is important, and early prevention strategies should be targeted at those most at risk. Identifying high-risk children at an early age, however, is currently difficult. OBJECTIVE: We sought to determine those factors present in early life that predict an increased risk of adult asthma. METHODS: A prospective cohort study of subjects at risk of asthma and atopy was undertaken in Poole, England. One hundred babies of atopic parents were recruited at birth. During the first 5 years of life, subjects were recalled annually, all respiratory events were reported, and skin prick tests and total serum IgE measurements were performed. At 11 and 22 years, bronchial hyperresponsiveness was also measured. Seventy-three subjects were followed up at 5 years, 67 at 11 years, and 63 at 22 years. RESULTS: Twenty-three (37%) adult subjects reported wheezing within the previous 12 months. Fifteen (25%) of these subjects showed signs of bronchial hyperresponsiveness and were regarded as asthmatic. Wheezing before the age of 2 years occurred in 28% and was not significantly related to adult asthma (odds ratio, 0.3; 95% CI, 0.03-1.7; P = .19). A positive skin prick test response to hen's egg, cow's milk, or both in the first year was independently predictive of adult asthma (odds ratio, 10.7; 95% CI, 2.1-55.1; P = .001; sensitivity, 57%; specificity, 89%). CONCLUSION: Prediction of adult asthma remains difficult. In this study of subjects at risk of atopy, skin sensitivity to hen's egg or cow's milk in the first year was predictive of adult asthma.

Adult↗
PubMed2001

Home apnea monitor use in preterm infants discharged from newborn intensive care units.

PURPOSE: To identify current factors associated with home apnea monitor use in preterm infants and to determine whether home monitor use was associated with a shorter length of hospital stay. SETTING: We evaluated neonates who were < or =34 weeks' estimated gestational age and admitted for neonatal intensive care. We excluded neonates with congenital anomalies, neonates transferred out before discharge, and neonates who died. METHODS: Using a database created with a computer-assisted tool that generates hospital notes, we reviewed the epidemiology of monitor use. Differences between neonates sent home with an apnea monitor and those who were not were evaluated by using stepwise logistic regression analysis to identify which factors were independently associated with a neonate being discharged with a monitor. RESULTS: We studied 14,532 neonates; 1588 (11%) were sent home with monitors and 12,944 (89%) were not. The most important variables associated with being discharged with a monitor were site of care and a diagnosis of apnea. Site variation remained significant when adjusted for gestational age, diagnosis of apnea, and a history of use of methylxanthines. When corrected for gestational age, monitor use was not associated with shorter hospital stays. CONCLUSION: The data suggest that monitor use is more dependent on physician preference than medical indication and is not associated with earlier hospital discharge.

Apgar Score↗
PubMed2001

Are very low birth weight infants born at high altitude at greater risk for adverse outcomes?

OBJECTIVE: To determine if neonatal intensive care at higher altitudes was associated with any variation in mortality or morbidity. METHODS: We reviewed demographic and outcome data on 5450 neonates with birth weights between 500 and 1500 g cared for in 76 different level II and III neonatal intensive care units (NICUs). The altitude break point of 4300 feet was prospectively chosen. Care was provided at 63 NICUs located below 4300 feet, "low-altitude," (n = 4534 neonates) and at 13 NICUs at or above 4300 feet, "high-altitude" (n = 916 neonates). RESULTS: Compared with neonates cared for at low altitude, neonates cared for at high altitude were more often non-Hispanic white and exposed to prenatal steroids. Neonates born at high altitude were more often treated with surfactant (60% vs 53%, P <.01). At 28 days of age, neonates cared for at high altitude were less often in room air (33% vs 50%, P <.01) compared with neonates cared for at low altitude. However, when corrected for barometric pressure, the calculated partial pressure of inspired oxygen at 28 days of age was lower for neonates cared for at high altitude compared with low altitude (165 +/- 80 vs 183 +/- 57, P <.01). There were no differences in the rates of mortality, severe intraventricular hemorrhage (grades 3 and 4), severe retinopathy of prematurity (stages 3 and 4), or necrotizing enterocolitis requiring surgical treatment. CONCLUSIONS: Being cared for at NICUs located above 4300 feet above sea level was not associated with any increase in adverse events compared with NICUs located below 4300 feet.

Altitude↗
PubMed2001

Increasing research capacity and changing the culture of primary care towards reflective inquiring practice: the experience of the West London Research Network (WeLReN).

A number of primary care research networks were set up throughout England in 1998 in order to (1) improve the quality of primary care research (2) increase the research capacity of primary care, and (3) change the culture of primary care towards reflective inquiring practice (NHSE, 2000b). It is not clear how best to operate a network to achieve these diverse aims. This paper describes the first 30 months of a network that adopted a whole system approach in the belief that this would offer the best chance of simultaneously achieving the three aims. A cycle of activity was designed to facilitate the formation of multidisciplinary coalitions of interest for research with complementary 'top down' and 'bottom up' programmes of work co-existing. At least 330 people participated in the generation of research questions of whom one third (33%) were general practitioners, 16% community nurses, 6% practice managers and other primary care practitioners. Over two fifths (43%) were 'key allies'--academics, health authority staff, community workers and project workers. One fifth (110) of all practices (500) in the WeLReN area have collaborated in at least one research project. The ratio of doctor:nurse participation in the 24 research project teams was markedly different in the supported coalitions (2:1) compared to projects devised and led by more experienced researchers (6:1). The evidence suggests that it is possible to operate a primary care research network in a way that develops coalitions of interest from different parts of the health care system as well as both 'top down' and 'bottom up' led projects. It is too early to tell if the approach will be able to achieve its aims in the long-term but the activity data are encouraging. There is a need for more research on the theoretical basis of network operation.

Community Networks↗
PubMed2001

Macrophage migration inhibitory factor expression in male and female ethanol-fed rats.

Macrophage migration inhibitory factory (MIF) regulates macrophage accumulation at sites of injury and can promote the inflammatory response. We studied MIF expression in the intragastric feeding rat model for alcoholic liver injury. Male and age-matched female rats were fed ethanol or dextrose with fish oil. Two groups of male rats were fed medium-chain triglycerides with ethanol or dextrose. Analysis of liver histopathology, lipid peroxidation, endotoxin, mRNA, and immunohistochemistry for MIF, tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) were carried out. Male and female rats fed fish oil and ethanol showed necroinflammatory liver injury and had the highest expression of MIF, TNF-alpha, and IFN-gamma in the liver. Decreased levels of MIF protein were seen in rats with higher endotoxin levels, suggesting that preformed MIF is released into the circulation. MIF is an important mediator of the inflammatory response in alcoholic liver disease and a potential therapeutic target.

Administration, Oral↗
PubMed2001

Normal human lymphocytes exhibit a wide range of methionine-dependency which is related to altered cell division but not micronucleus frequency.

The underlying cause(s) of methionine-dependency and its relevance to cancer remains unclear. We aimed to determine whether (i) normal human lymphocytes exhibit methionine-dependency, (ii) baseline levels of genetic damage are related to methionine-dependency and (iii) methionine-dependence can be explained, in part, by common polymorphisms in methionine synthase and methylenetetrahydrofolate reductase (MTHFR). Genetic damage was measured in lymphocytes of 52 volunteers (29--65 years) using the cytokinesis-block micronucleus assay. Methionine-dependency was assessed by culturing cells in serum-free media containing 0.1 mM L-methionine and 0 mM D,L-homocysteine (met(+)hcy(-)) or 0 mM L-methionine and 0.2 or 0.4 mM D,L-homocysteine (0.2/0.4-hcy(+))(met(-)hcy(+)). Mitogenesis was stimulated with phytohaemagglutinin. Cytokinesis was inhibited by adding cytochalasin B at 44 h. Ninety-six hours after PHA, cells were transferred to microscope slides. Cell proliferation was measured by counting binucleated cell frequency and calculating nuclear division index. Volunteers were classified into tertiles of methionine-dependence according to the growth of their cells in met(-)hcy(+) media (relative to growth in met(+)hcy(-) media). Average cell division, as a percentage of division in met(+)hcy(-) media, was approximately 5, 26 and 70% in 0.2-hcy(+) media and 29, 70 and 142% in 0.4-hcy(+) media for the high, mid and low tertiles of methionine-dependence, respectively. Micronucleus frequency did not vary between these tertiles (P > 0.6). In both met(+)hcy(-) and met(-)hcy(+) media, cell division was not affected by polymorphisms in MTHFR (C677T, A1298C) or methionine synthase (A2756G). Cell division in met(-)hcy(+) media was negatively correlated with division in met(+)hcy(-) media (P = 0.05 and 0.007 for 0.2 and 0.4-hcy(+), respectively). Methionine-dependent lymphocytes had higher levels of cell proliferation in met(+)hcy(-) media than methionine-independent lymphocytes (P = 0.089 and 0.01 for 0.2 and 0.4-hcy(+), respectively). However, this difference was not apparent in previous experiments when cells were grown in media containing 10% fetal calf serum. These findings show that there is a wide inter-individual variation in the degree of methionine-dependency of normal human lymphocytes in vitro. Methionine-dependency does not appear to alter the risk for chromosomal mutation as measured by the micronucleus assay. We discuss the possible relevance to cancer of increased cell division in methionine-dependent cells under methionine-replete and serum-free media conditions.

5-Methyltetrahydrofolate-Homocysteine S-Methyltran↗
PubMed2001

Upregulation of the maturation-inducing steroid membrane receptor in spotted seatrout ovaries by gonadotropin during oocyte maturation and its physiological significance.

Changes in ovarian maturation-inducing steroid (MIS; 17,20 beta, 21-trihydroxy-4-pregnen-3-one [20 beta-S]) membrane receptor concentrations during the reproductive cycle were investigated in spotted seatrout (Cynoscion nebulosus) captured at their spawning grounds. Ovarian receptor concentrations increased gradually during ovarian recrudescence and subsequently increased rapidly during oocyte maturation, reaching 3.5-fold the prematuration values by the beginning of ovulation. The significant elevation of receptor concentrations by the germinal vesicle migration stage of oocyte maturation was accompanied by increases in circulating levels of gonadotropin (LH, GTH II) and MIS (20 beta-S). The regulation and physiological significance of the increase in ovarian MIS membrane receptor concentrations were investigated in a double in vitro incubation system. Incubation of fully grown, follicle-enclosed oocytes with hCG (10 IU/ml) for 6 h caused a two- to fourfold increase in oocyte and ovarian MIS receptor concentrations and the development of oocyte maturational competence (OMC; ability to complete oocyte maturation in vitro in response to exogenous 20 beta-S in a second incubation). Both upregulation of the MIS receptor and development of OMC in response to gonadotropin were blocked by coincubation with actinomycin D or cycloheximide, which are inhibitors of mRNA and protein synthesis, respectively, but not by cyanoketone, which is an inhibitor of 3 beta-hydroxysteroid dehydrogenase-dependent steroid synthesis. Incubation with a variety of steroids, including 20 beta-S, failed to increase receptor concentrations or to induce OMC, further supporting a steroid-independent mechanism of gonadotropin action. In contrast, insulin-like growth factor I (IGF-I) mimicked the actions of gonadotropin, which suggests IGF-I may be a component of the hormone signaling pathway. A close correlation was found between the relative increase in MIS receptor concentrations and the percentage of oocytes that became maturationally competent after treatment with different concentrations of gonadotropins and drugs that elevate cAMP levels. The finding that upregulation of the MIS receptor in response to gonadotropin and other treatments is invariably associated with the development of OMC indicates that these two processes are intimately related, and it suggests that the increase in MIS receptor concentrations is a critical regulatory step in the hormonal control of oocyte maturation.

3-Hydroxysteroid Dehydrogenases↗
PubMed2001

Disruption of neuroendocrine control of luteinizing hormone secretion by aroclor 1254 involves inhibition of hypothalamic tryptophan hydroxylase activity.

Mechanisms governing the effect of polychlorinated biphenyl (PCB) toxicity on hypothalamic serotonergic function and the neuroendocrine system controlling LH secretion were investigated in Atlantic croaker (Micropogonias unulatus) exposed to the PCB mixture Aroclor 1254 (1 microg x g body weight(-1) x day(-1)) in the diet for 30 days. PCB treatment caused a decrease in hypothalamic 5-hydroxytryptamine (5-HT) concentrations and significant inhibition of hypothalamic tryptophan hydroxylase (TPH), the rate-limiting enzyme in 5-HT synthesis, but did not alter the activity of monoamine oxidase, the catabolic enzyme. Further, PCB treatment caused significant decreases in GnRH content in the preoptic-anterior hypothalamic area. Significant decreases in pituitary GnRH receptor concentrations and the LH response to the GnRH analogue (GnRHa) were also observed in PCB-exposed fish, possibly as a consequence of a decline in GnRH release. The possible association between impaired serotonergic and neuroendocrine functions after PCB treatment was explored using serotonergic drugs. Treatment of croaker with p-chlorophenylalanine, an irreversible TPH inhibitor, mimicked the effects of PCB on the GnRH system and the LH response to GnRHa. Bypassing the TPH-dependent hydroxylation step with the administration of 5-hydroxytryptophan restored 5-HT to control levels and prevented the deleterious effects of PCB on the neuroendocrine parameters. Moreover, slow-release GnRH implants prevented the PCB-induced decline in GnRH receptors and restored the LH response to GnRHa, suggesting that GnRH therapy can reverse PCB-induced disruption of LH secretion. These results demonstrate that TPH is one of the targets of PCB neurotoxicity and indicate that a decrease in 5-HT availability in PCB-exposed croaker results in disruption of the stimulatory 5-HT/GnRH pathway controlling LH secretion.

5-Hydroxytryptophan↗
PubMed2001

CD44s expression is reduced in endometriotic lesions compared to eutopic endometrium in women with endometriosis.

Immunohistochemical expression of the standard form of CD44 (CD44s) was examined in archival formalin-fixed endometriotic and matching eutopic endometrial tissue obtained from 25 patients in proliferative (N = 16) and secretory (N = 9) stages of the cycle. CD44s was expressed in most eutopic endometria and endometriotic tissue. Its expression was significantly higher in secretory than in proliferative phase endometrium. It was low but detectable in 13 of 16 proliferative phase biopsies. The majority of these endometria exhibited both glandular and stromal staining (63%). In the secretory phase, glandular cells exhibited a significantly greater intensity of staining compared to stromal cells. In endometriotic tissue, stromal cell CD44s expression did not differ between tissue types in either stage of the cycle. In contrast, glandular expression in endometriotic tissue during the secretory phase was reduced (p < 0.05) compared to eutopic endometrium. It was absent in 66% of cases and reduced in the remaining cases. Our results indicate a correlation between CD44s expression and secretory differentiation of endometrial glands in the cycle, suggesting hormonal regulation of its expression. This cyclic pattern of CD44s expression was lost in corresponding endometriotic tissue. Reduced expression of CD44s in endometriotic tissue may provide insight into the pathophysiology of endometriosis.

Adult↗
PubMed2001

Aging cohort of perinatally human immunodeficiency virus-infected children in New York City. New York City Pediatric Surveillance of Disease Consortium.

BACKGROUND: New York City (NYC) pediatricians are now caring for fewer HIV-infected infants and more school age children and adolescents than earlier in the epidemic. METHODS: Clinical, laboratory and demographic data were abstracted from medical records at 10 NYC centers participating in the CDC Pediatric Spectrum of HIV Disease project. Pediatric AIDS cases and HIV-related deaths reported to the NYC Department of Health were examined. RESULTS: Median age of HIV-infected children in care increased from 3 years in 1989 to 1991 to 6 years in 1995 to 1998. The number of HIV-infected women giving birth in NYC declined 50% from 1990 to 1997 (1630 to 831); increasing numbers were identified prenatally (14% in 1989; 78% after 1995); and most received prenatal zidovudine prophylaxis (73% in 1997). Estimated perinatal transmission decreased to 10% by 1997. Improved identification of seropositive status in infants was associated with an increased proportion of infected infants receiving Pneumocystis carinii pneumonia (PCP) prophylaxis, 84% in 1997. AIDS free survival was longer for children born 1995 to 1998 than for those born before 1995, P = 0.004. In 1998 among children with advanced immunosuppression (CDC category 3), 66% were prescribed 3 or more antiretroviral medicines and 88% received PCP prophylaxis. Citywide AIDS cases and HIV-related deaths fell precipitously beginning in 1996. CONCLUSIONS: Based on the observations of this study, the cohort of NYC HIV-infected children in care is aging, associated with a decline in new HIV infections, high rates of PCP prophylaxis and increased time to AIDS. Falling HIV-related deaths citywide support these observations.

Aging↗
PubMed2001

Adult endomysial antibody-negative coeliac disease and cigarette smoking.

OBJECTIVE: To determine the relative incidence and characteristics of endomysial antibody (EMA)-negative coeliac disease in adults. DESIGN: Retrospective analysis of prospectively collected data on adults with newly diagnosed coeliac disease, with determination of EMA status before gluten withdrawal. SETTING: District general hospital (secondary care institution). PARTICIPANTS: Sixty consecutive incident cases. MAIN OUTCOME MEASURES: (i) Proportion of cases who were EMA-negative; (ii) comparison of clinical and laboratory variables at diagnosis for EMA-positive and EMA-negative subjects. RESULTS: Fifteen subjects (25%, 95% CI 15-38%) were EMA negative, of whom only two were IgA deficient. There was clinical evidence in all 15 patients and histological evidence in 13 patients of a response to gluten withdrawal. No significant differences were found between EMA-positive and EMA-negative subjects with respect to histological features, age, gender, clinical manifestations, concurrent autoimmune disorders, family history of coeliac disease, or haemoglobin and albumin concentrations at diagnosis. However, EMA-negative status at diagnosis was associated strongly with current or recent cigarette smoking (OR 7.0, 95% CI 1.7-31.5, P= 0.003). CONCLUSIONS: A substantial minority of patients with otherwise typical coeliac disease are EMA negative, and most of these are IgA replete. The value of EMA as a screening tool is therefore limited. EMA status in untreated coeliac disease correlates strongly with cigarette smoking history: this may be of pathogenic significance, given the previously demonstrated association between smoking and the risk of coeliac disease.

Adult↗
PubMed2001

Propionibacterium microaerophilum sp. nov., a microaerophilic bacterium isolated from olive mill wastewater.

A new gram-positive, facultative anaerobic, microaerophilic bacterium, designated strain M5T, was isolated from a decantation reservoir of olive mill wastewater. The cells were rod-shaped, non-motile, non-spore-forming and catalase-negative. Growth occurred at pH ranging from 4.5 to 9.5, with optimum growth at 7.0. The optimum temperature for growth was around 30 degrees C. Although growth occurred under anaerobic and aerobic conditions, the optimum O2 concentration for growth was determined as 5% in the gas phase of the culture. During anaerobic growth, glucose or lactate were mainly fermented to propionate, acetate and CO2. In the presence of O2 (more than 2%), glucose was oxidized completely to CO2. The G+C content of the DNA was 67.7+/-0.6 mol% and 16S rRNA gene analysis revealed that the new isolate belonged to the cluster of 'dairy' propionibacteria, Propionibacterium acidipropionici being its closest phylogenic relative (97.5% similarity). However, the level of DNA relatedness between strain M5T and P. acidipropionici was 56.2%. Consequently, both the phenotypic (range of substrates used) and genotypic characteristics of strain M5T allow it to be assigned as a new species of the genus Propionibacterium, Propionibacterium microaerophilum sp. nov. The type strain is strain M5T (= CNCM I-2360T = DSM 13435T).

Aerobiosis↗
PubMed2001

Fear as the main feature of epileptic seizures.

OBJECTIVES: There are circumstances in which partial seizures may be misdiagnosed as acute psychiatric disturbances. In particular, when fear is the prominent feature the patient may be considered for years as having panic attacks. Eight patients in whom fear was the main symptom of the seizures are reported on. Patients who had a proved lack of consciousness during the fits and patients in whom fear was just fear of having a seizure were excluded. The ictal involvement of temporal limbic and frontal structures in those patients with fear of particular intensity was studied. METHODS: The localisation of the epileptogenic zone was assessed by prolonged interictal EEG recordings as well as ictal video-EEG recording of at least one seizure in every patient; five had ictal SPECT and four had chronic stereotactic implantation of depth electrodes (SEEG). In six patients, a cortical resection was performed with an Engel's class 1 outcome (minimum 28 months follow up, except for two patients). RESULTS: Localisations of primary epileptogenic zones were right temporal in three patients, left temporal in three, bitemporal in one, and frontal in one. In all cases, diagnosis of epileptic seizures could be clinically evoked because of the stereotypy of fits and of associated symptoms. The association of a fear sensation, autonomic symptoms, and coordinated behaviour suggests disturbance of a particular system. The SEEG data argue for temporolimbic and prefrontal lobe involvement in the expression of ictal fear. CONCLUSIONS: In intense ictal fear, with coordinated behaviour and autonomic features, the discharge may involve or interfere with a physiological complex information processing network. This network involves orbitoprefrontal, anterior cingulate, and temporal limbic cortices.

Adolescent↗
PubMed2001

Clinical factors of drug resistance in juvenile myoclonic epilepsy.

Juvenile myoclonic epilepsy is a comparatively benign form of idiopathic generalised epilepsy. Little is known about the prevalence of difficult to treat or drug resistant patients. Among 155 consecutive patients with newly diagnosed juvenile myoclonic epilepsy evaluated between 1981 and 1998 and followed up for at least 1 year (61 men, 94 women; aged 15-70 years, mean 33 (SD 10.3); onset of juvenile myoclonic epilepsy at the age of 14.5 (SD 3.7), range 6-26; follow up 1-52 years, mean 13.5 (SD 9.9)), there were 15 pseudoresistant patients (9.7%: lack of compliance (eight), insufficient treatment (three), abnormal lifestyle (four)) and 24 patients (15.5%) who had persisting seizures despite adequate therapy and lifestyle. Clinical features associated with drug resistance were (1) the presence of psychiatric problems (58.3% v 19%; chi(2) p<0.001) and (2) independently, the combination of seizure types (Fischer's exact 2 by 4, p=0.0026). Three types were present in 62.5% of resistant patients versus 23.3% in non-resistant patients (chi(2), p=0.0001). None of the resistant patients had myoclonic jerks as the only seizure type or a combination of absences and myoclonic jerks. Family history of epilepsy, age at onset of seizures, sex, presence of photoparoxysmal response, results of conventional neuroimagings (CT and MRI), and delayed diagnosis were not significantly associated with drug resistance. There is thus a significant subgroup of patients with juvenile myoclonic epilepsy who pose difficult therapeutic problems, and the prevalence of resistant cases may be increased in the experience of a referral epilepsy centre.

Adolescent↗