Differences in strategies for the diagnosis and treatment of neurologic disease among British and American neurologists.
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Biomedical subjects
Publications and source records attributed to R G Feldman.
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The relationships between magnitude of response to orally administered carbidopa/levodopa (CD/LD) and serum/cerebrospinal fluid (CSF) concentrations of levodopa (LD), 3-O-methyldopa (3-O-MD), and homovanillic acid (HVA) were studied in 15 patients with chronic LD-treated Parkinson disease. The degree of clinical benefit derived from a 25/250 tablet of CD/LD could not be correlated with absolute serum levels of LD, 3-O-MD or LD/3-O-MD ratios. CSF levels of LD and 3-O-MD were also not associated with improvement. CSF levels of HVA, however, did significantly correlate with magnitude of response to LD. Furthermore, CSF HVA levels were not dependent on previous LD dosage. Our data suggest that in chronic LD-treated patients, central factors related to the integrity of the nigrostriatal tract may be a more important determinant of magnitude of response to LD than peripheral elements affecting the amount of LD entering the central nervous system.
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The combination of carbidopa and levodopa (Sinemet) is a highly effective treatment for the symptoms of Parkinson's disease. However, side effects, such as abnormal involuntary movements, fluctuations in motor performance, and "wearing off" phenomena limit its long-term usefulness in some patients. Open-label studies show that controlled-release Sinemet CR is effective in reducing motor fluctuations. This report discusses the results of a 14-week double-blind crossover study comparing the efficacy and tolerability of standard Sinemet with controlled-release Sinemet CR. Overall, there were no statistically significant differences in efficacy between Sinemet CR and standard Sinemet on any of the major efficacy measures, suggesting a clinical equivalence in terms of treating the symptoms of Parkinson's disease. The study also supports the tolerability of Sinemet CR. In summary, Sinemet CR holds the promise of reducing some disturbing side effects of long-term levodopa therapy, thus achieving optimal control of parkinsonian symptoms.
In 1977 the Department of Microbiology, University College Hospital, London introduced an integrated data processing system. The system was designed primarily to produce individual reports on specimens processed. Input was via visual display units (VDU's) using nmemonic codes. Additionally data is sorted by the software to provide daily, weekly, monthly and annual listings for epidemiological use. Listings concerning specific problem area can be produced as required. As computing power and data storage systems become cheaper it should be possible to improve upon the quality of epidemiological information available. A continuous surveillance system is envisaged where each day all potential outbreaks are displayed and help with their management is offered. Information on incidence of infections and changing trends (such as anti-microbial resistance patterns) would be instantly available in numerical and graphical form. Modern colour VDU's and new programming techniques would make the system especially easy to use by the untrained operator.
We previously demonstrated a negative correlation between blood lead level and motor nerve conduction velocity in 202 asymptomatic 5 to 9-year-old children living near a lead smelter in Idaho. Blood lead levels ranged from 13 to 97 micrograms/dL. To determine whether a threshold exists between blood lead level and maximal motor nerve conduction velocity, we conducted three regression analyses on these data: a "hockey stick" regression, a logistic regression, and a quadratic regression. We found evidence for a threshold in all three analyses: at a blood level of 30 micrograms/dL in the "hockey stick" regression, at 20 micrograms/dL in the logistic, and at 25 to 30 micrograms/dL in the quadratic. Neither age, sex, socioeconomic status, nor duration of residence near the smelter significantly modified the relationship. These analyses confirm that asymptomatic increased lead absorption causes slowing of nerve conduction, but they also indicate that measurement of maximal motor nerve conduction velocity is an insensitive screen for low-level lead toxicity.
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Alzheimer's disease is a leading cause of morbidity and mortality among the elderly. Several families have been described in which Alzheimer's disease is caused by an autosomal dominant gene defect. The chromosomal location of this defective gene has been discovered by using genetic linkage to DNA markers on chromosome 21. The localization on chromosome 21 provides an explanation for the occurrence of Alzheimer's disease-like pathology in Down syndrome. Isolation and characterization of the gene at this locus may yield new insights into the nature of the defect causing familial Alzheimer's disease and possibly, into the etiology of all forms of Alzheimer's disease.
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Visual evoked potentials (VEPs) and contrast sensitivity (CS) were studied in patients affected by maculopathy. VEP delays and CS reduction were demonstrated in each affected eye. In distinction to patients affected by multiple sclerosis (MS), in maculopathy patients VEP latency is independent of the orientation of the grating stimulus. It is proposed that stimulating with more than one pattern orientation is useful in the differential diagnostic use of VEPs.
A 39-year-old woman presented at 34 weeks gestation with a febrile illness. This initially settled but recurred 6 days later, when uncontrolled vaginal bleeding necessitated caesarian section. At operation, vesicles were seen on the mother's hyperaemic uterus. The infant developed tachypnoea, bradycardia, cerebral irritation, an enlarged liver and spleen, intravascular coagulation and a transient rash. Mother and child made a full recovery. Coxsackie B2 virus was isolated from the infant and rises in the titre of Coxsackie B virus-specific IgM were detected in mother and child.
Symptoms that develop in workers after repeated mechanical injury may be overlooked until the disability affects their productivity and safety. Modifications in the design of hand-operated tools or adaptations in production ergonomics may prevent further damage and permit affected workers to recover while avoiding the development of repetitive cumulative trauma in workers who are new to the job task. This article describes the results of an on-site survey, a biomechanical analysis, and a special neurologic assessment in an electronic assembly plant and provides a structured approach to worker surveillance and intervention to reduce the risk of carpal tunnel syndrome caused by repetitive motions.
Cerebral glucose metabolic rate (CMRGlu), measured by positron emission tomography, was bilaterally and symmetrically reduced in two patients with autosomal dominant Alzheimer's disease. Supramarginal gyri and temporal lobes were most severely affected. An isolated reduction of CMRGlu in the left supramarginal gyrus was observed in one asymptomatic at-risk subject.
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Mycoplasmal infections may be complicated by a wide variety of systemic syndromes, including neurological disorders. Circumstantial evidence suggests that these are immunologically-induced. A detailed study of five patients with proven mycoplasma pneumoniae and central nervous system signs showed that immunological factors were involved and suggested that the neurological symptoms were due to a vasculopathy.
A murine monoclonal antibody, which recognises various serotypes of group B Streptococcus in formalin fixed, paraffin embedded tissue, was used to show the organism in necropsy specimens of newborn infant lung by an indirect immunoperoxidase technique. The method seemed to be complementary to that of Gram staining, and may be successfully used to identify group B Streptococcus antigen in histopathological material.
Two hundred and fifty six unselected women, 50 of whom had urinary symptoms (frequency of urination or dysuria, or both), and who were attending a department of genitourinary medicine, were investigated. The urinary symptoms were associated both with pyuria and the isolation of undoubted pathogens from midstream urine (MSU) specimens. No associations were found between urinary symptoms and the isolation of Neisseria gonorrhoeae or Chlamydia trachomatis from the urethra or cervix; the recovery of Mycoplasma hominis from the urethra, cervix, or MSU; the recovery of Trichomonas vaginalis or Candida albicans from the vagina; or the presence of bacterial vaginosis. Urethral leucocytosis was associated with the isolation of T vaginalis but not with the recovery of N gonorrhoeae, C trachomatis, C albicans, or urinary pathogens. Pyuria was associated with the isolation of urinary pathogens and with the presence of trichomoniasis; it was not associated with the recovery of C trachomatis or M hominis.
Three cases of a syndrome resembling neuroleptic malignant syndrome are described in patients never exposed to neuroleptics. Each patient had a long history of Parkinson's disease treated with a carbidopa-levodopa combination. Two patients developed the syndrome when administration of the drug was discontinued temporarily. One developed the syndrome before the "drug holiday," and then died during the holiday because of this complication.