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Biomedical subjects

R Broughton

Publications and source records attributed to R Broughton.

At least 37 records · Page 2Linked to original sources
PubMed1986

Nonconvulsive generalized status epilepticus: clinical features, neuropsychological testing, and long-term follow-up.

We studied 13 episodes of nonconvulsive generalized status epilepticus (NGS) in 10 adults. The syndrome may start in middle or late life and is often mistaken for psychiatric disorders. Some patients have shown good retention of language abilities, except for reduced fluency, despite impairment in other higher functions. In most patients, the syndrome recurs for several years despite anticonvulsant therapy. Transitional cases of NGS with lateralizing EEG features exist, and some cases are probably due to secondary generalization from a temporal or frontal focus.

Adolescent↗
PubMed1985

Excessive fragmentary myoclonus in NREM sleep: a report of 38 cases.

We report 38 consecutive patients referred to a sleep disorder clinic who on diagnostic polysomnography showed excessive amounts of brief fragmentary myoclonus throughout all stages of NREM sleep. Almost all patients were male despite a reasonably equal sex distribution of referral. The phenomenon was found associated with sleep-related respiratory problems, periodic movements in sleep (PMS), narcolepsy, intermittent hypersomnia and (rarely) insomnia. It also occurred associated with excessive daytime sleepiness (EDS) as an isolated polysomnographic finding apart from some degree of sleep fragmentation.

Adult↗
PubMed1985

Does memory impairment exist in narcolepsy-cataplexy?

Approximately one-half of patients with the narcolepsy-cataplexy syndrome suffer from subjective memory problems, mainly involving recent events. Ten untreated narcoleptic patients (7 male, 3 female, aged 28-65 years) with such problems and 10 matched controls were given a battery of tests to study the complaint. Tests included the digit span, Knox cube, recurring figures (verbal and nonverbal), visual reproduction, paired associates learning and logical memory test, plus naming and fluency tests to control for language capabilities. No significant intergroup differences were found. It is concluded that narcoleptics do not have a true organic memory deficit, but rather experience a subjective problem due to drowsiness which they are able to suppress during short testing sessions in a laboratory environment.

Adult↗
PubMed1985

Reappearance of electroencephalogram slow waves in extended sleep with delayed bedtime.

A three-part study using prolonged nights of sleep was undertaken to verify Broughton's hypothesis of an approximate 12-h ultradrian rhythm of human slow wave sleep (SWS). Part I consisted of 2 8-h adaptation nights followed by a prolonged 15-h night of sleep with bedtime at midnight. A significant return of SWS occurred 12 h and 32 min after the first appearance of SWS. In part II, after 1 adaptation night, subjects were asked to sleep for 15 h but bedtime was delayed until 0400 h. A two-peak return of SWS was observed with a first significant return at 1228 h and a second significant return at 1745 h (i.e., 13 h and 32 min after the first appearance of SWS). In part III, bedtime was again delayed to 0400 h; but subjects were given 3 nights to adapt before the 15 h extended sleep. A single significant return of SWS was then observed at 1656 h, i.e., 12 h and 24 min after the first appearance with no peaks around 1200 h, thus exhibiting the same pattern as in part I. These results suggest that the return of SWS seen normally between 1200 and 1500 h is relatively well entrenched since it remained present in the extended night following sudden bedtime delay. It appears, moreover, that SWS does follow a bimodal 12-h rhythm, which is seen immediately upon extended delayed sleep and can be fully phase-shifted with habituation.

Adolescent↗
PubMed1984

Fragmentary pathological myoclonus in NREM sleep.

A 42-year-old patient is reported who presented with marked daytime sleepiness and in whom the only major nocturnal polysomnographic abnormality was intense fragmentary (partial) myoclonus occurring with equal frequency in all stages of NREM sleep associated with some degree of sleep fragmentation. The myoclonus was very brief (less than 150 msec duration), aperiodic and recurred in asynchronous and asymmetrical fashion over the legs, arms and face. It appears unrelated to the clinically similar physiological myoclonus of REM sleep. Other main sleep disorders such as periodic movements, restless leg syndrome, sleep apnea and narcolepsy-cataplexy were excluded by history and polysomnography.

Adult↗
PubMed1984

Gustave Flaubert's illness: a case report in evidence against the erroneous notion of psychogenic epilepsy.

The concept of psychogenic epilepsy was recently revived by Sartre (L'Idiot de la Famille, 1971-2) in relation to Gustave Flaubert's epilepsy, which he believed was secondary to hysterical neurosis and not due to a cerebral lesion. A detailed clinical description of Gustave Flaubert's personal and medical history from birth to death is provided. The relationships between his epileptic seizures and both his personal life and the response of others to the attacks are discussed, as is the interaction between seizure occurrence and his literary work and productivity. The various diagnoses made by medical and nonmedical persons during and after Flaubert's lifetime are then reviewed. Particular emphasis is given to Sartre's purely psychogenic interpretation of the seizures, to his total disinterest in their medical aspects, and to the fact that he did not obtain any medical opinions. It is shown that a definitive diagnosis can be made for Flaubert's illness--that of epilepsy associated with a quite normal psychosocial response by current standards. Moreover, the clinical nature of the seizures and other clinical details permit the more specific diagnosis of "complex partial epilepsy of occipital-temporal origin, secondary to lesion of the left posterior hemisphere with occasional secondary generalization of seizures." The concept of the existence of "psychogenic epilepsy" is reaffirmed as erroneous, despite the occasional precipitation of seizures in some individuals by psychological factors. Finally, Gustave Flaubert's case, like Dostoevski's, points to the possible coexistence of a serious and poorly controlled form of epilepsy with true literary genius without the latter being dependent in any way on the former.

Epilepsy↗
PubMed1984

Corticosteroid injections into the hands and feet.

Sixty-four patients who received corticosteroid injections into the hands and feet were followed up for a period of up to three years. Injections offer a safe, popular, limited advance in the treatment of chronic eczema and psoriasis in these areas. The periods of remission varied from a few weeks to several months. The concurrent use of topical treatment was reduced although most patients continued to use them. No subcutaneous atrophy was observed and no serious side effects occurred. Most patients were willing to receive the injections again.

Eczema↗
PubMed1983

The physiological (EEG) nature of drowsiness and its relation to performance deficits in narcoleptics.

Ten narcoleptics off medication were compared to matched controls to determine the pattern and level of electroencephalographic (EEG) vigilance, and its relation to performance ability on the 1 h Wilkinson auditory vigilance task. The narcoleptics performed significantly more poorly and spent significantly less time in wakefulness than controls. The EEG of the patients revealed continual fluctuations between wakefulness, stage 1A (slowed and diffusing alpha) and stage 1B (theta activity). Stage 2 sleep only occurred briefly in 4 patients. Stages 3, 4 and REM sleep were never encountered. Controls were continually awake aside from very brief appearances of stage 1A in 5 subjects. Narcoleptic performance during stages 1B and 2 was characterized by lapses (response omissions). Patients also demonstrated significantly more lapses as well as false positive responses than controls during wakefulness and stage 1A. Poorer performance even during wakefulness was demonstrated to be related to inability to sustain wakefulness over time. The results clarify the temporal pattern of physiological vigilance during performance in narcoleptics and also demonstrate the insufficiency of the lapse-microsleep formulation in explaining performance deterioration in these patients.

Adult↗
PubMed1983

Life effects of narcolepsy: relationships to geographic origin (North American, Asian or European) and to other patient and illness variables.

A recent questionnaire survey of the life-effects of narcolepsy in 180 patients, 60 each from North American, Asian and European populations, compared to similarly distributed age and sex matched controls, documented multiple and marked effects on work, education, driving, accidents, recreation, personality, memory and other parameters. The data have now been further analysed according to the patients' geographic (culturo-genetic) origin and to a number of other patient and illness variables. The three different geographic populations showed few significant differences for the some 160 life-effects items in the questionnaire. This strongly indicates that these are an integral part of the disease or of the human reactions to it. Most of the few significant population differences appeared cultural in origin (e.g., concerning driving records, personality changes), although a few may possibly reflect genetic differences (e.g., visual problems). Analysis of the pooled data according to respondees' age, sex, age at illness onset, duration of illness and treatment led again to relatively few significant findings. It is concluded that, in general, once the disease has been diagnosed, all the major life effects are present and remain so. The results strongly support the contention that most life-effects are not related to the diagnostic 'tetrad' symptoms themselves but rather to excessive daytime sleepiness, the symptoms most resistant to ant-narcoleptic treatment.

Accidents, Traffic↗
PubMed1982

Auditory evoked potentials compared to performance measures and EEG in assessing excessive daytime sleepiness in narcolepsy-cataplexy.

The AEP to the repetitive stimuli of the Wilkinson auditory vigilance task was compared between untreated patients with narcolepsy-cataplexy and matched controls for periods during which the tones were preceded by 13 sec or more of wakefulness (defined by EEG-polygraphic criteria). During these periods it had been found previously that narcoleptics did not perform worse than did controls. The AEP, nevertheless, showed significant differences for narcoleptics. These were similar to changes described for drowsiness in normals. The AEP, therefore, showed changes related to excessive day time drowsines in narcolepsy-cataplexy when a sensitive performane measure and visual analysis of EEG-polygraphic recordings did not.

Adult↗
PubMed1982

Human consciousness and sleep/waking rhythms: a review and some neuropsychological considerations.

The relevance of sleep/waking rhythms to issues of human consciousness is reviewed from data in the literature and from personal studies. Consciousness is often considered to be markedly attenuated or absent in sleep. There is, however, much evidence for a rich subjective experience during sleep, much of which is not recalled later. This implies that William James' "stream of consciousness' persists continuously throughout sleep as well as wakefulness, but that problems of memory recall interfere with its being reported as such. Sleeping subjects show selective awareness of external stimuli, with significant stimuli generally leading to awakening and relatively nonsignificant stimuli, at least at times, being incorporated into the ongoing mental activity of REM or NREM sleep. Mentation throughout sleep is characterized by a high degree of autonomy and little willful control. Creative insight and problem solving of a very high order may occur in sleep and involve either dreaming or thought-like mentation. Parameters of waking consciousness show possibly sleep-related rhythmic fluctuations at both circadian (24 hr sleep/waking) and ultradian (90-120) min, NREM/REM sleep) rates. Moreover, waking consciousness is markedly influenced by the quality of temporal stability of preceding sleep. A substantial number of so-called "altered states of consciousness" is found to involve primarily or exclusively dysfunction of sleep/waking mechanisms. Cerebral lesions can produce selective impairment of aspects of sleep mentation. It is concluded that further analysis of subjective awareness in sleep or in partial sleep states is very relevant and indeed vital to a more comprehensive understanding of human consciousness.

Arousal↗
PubMed1981

Daytime performance deficits and physiological vigilance in untreated patients with narcolepsy-cataplexy compared to controls.

Ten patients, 7 female, 3 male, aged 17-65 years (mean 40) with narcolepsy-cataplexy were compared off treatment to matched controls on 4 performance tests. The tests were the 1 h Wilkinson auditory vigilance task, and 3 shorter tests including the 4-choice serial reaction time, the paced auditory serial addition task (PASAT) and digit span. Tests were counterbalanced and polygraphic recordings were done during all but the 4-choice serial RT. Subjective sleepiness was assessed by the 1-7 levels of the Stanford Sleepiness Scale and effort in the tests by a similar 1-7 scale. Practice sessions were held. Narcoleptics showed poorer performance on the more monotonous tests of auditory vigilance (fewer hits) and the 4-choice serial RT (longer reaction times, more 'gaps'). There were no significant differences between groups on the other performance tests. Narcoleptics were subjectively sleepier during all tests and over-all. But there was no good correlation between perceived degree of sleepiness and performance. They also expressed greater effort to perform the PASAT. The narcoleptics showed greater amounts of drowsiness and light sleep only during the 1 h vigilance test. For the detections of those signals (shorter times) occurring after 13 sec or more of polygraphic wakefulness, narcoleptics performed as well as controls.

Adolescent↗
PubMed1981

Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls.

A questionnaire survey has been made of the life effects of narcolepsy in 180 patients, 60 each from North American, Asian and European populations, with 180 similarly distributed age and sex matched controls. Life-effects were attributed by the patients to the primary symptoms of excessive daytime drowsiness, sleep attacks, cataplexy, vivid hypnagogic hallucinations and sleep paralysis, and also to other frequent symptoms such as visual problems (blurring, diplopia) and memory impairment. Occupational problems were prevalent (over 75%) and included statistically significant deleterious effects upon performance, promotion, earning capacity, fear of or actual job loss and increased disability insurance. Driving was greatly affected and patients fell asleep at the wheel more frequently (66%), had near or actual accidents from drowsiness or falling asleep at the wheel (67%), and could experience cataplexy (29%) or sleep paralysis (12%) while driving. Work or home accidents attributed to sleepiness or sleep (49%) or related to smoking (49%) were much more common in patients. There were also deleterious effects on education, recreation and personality related to disease. Narcolepsy can produce a variety of life-effects probably more serious and pervasive than, for instance, those of epilepsy, therefore emphasizing the importance of early diagnosis and treatment.

Accidents↗