Biomedical subjects
T Betts
Publications and source records attributed to T Betts.
Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part I.
Three hundred and forty three patients with attack disorder labelled as epilepsy were admitted for assessment to a Neuropsychiatry ward in a small English mental hospital over a 5 year period. After assessment it was decided that 63% (215) of these patients had epilepsy, but in 128 (37%) a diagnosis of non-epileptic seizures was made. Just over a third of these patients (46) had an additional history of present or past epileptic seizures as well, so that 24% of the total population had non-epileptic seizures only. The methods used to make this diagnosis are reviewed and an attempt made to classify the non-epileptic attacks from which the patients were suffering. A variety of management strategies were offered and at discharge from hospital the majority of patients had practically lost their non-epileptic seizures. At follow-up 2 years later, seizures had returned in most patients. In 8% of the patients it was clear that the diagnosis of non-epilepsy had been erroneous. The importance of classifying the kind of non-epileptic event the patient suffers from and of translating treatment in hospital to the community is emphasized.
Diagnosis, management and prognosis of a group of 128 patients with non-epileptic attack disorder. Part II. Previous childhood sexual abuse in the aetiology of these disorders.
In a group of female in-patients clinically diagnosed as having non-epileptic attack disorder there was an increased incidence of a proven previous history of sexual abuse in childhood, when compared with a group of women with epilepsy and a group of women with other psychiatric disorders admitted to the same ward. This was particularly true of women with the 'swoon' and 'abreactive' type of non-epileptic attack disorder (see Part I). The incidence of a history of previous abuse was similar to the two control groups for other types of non-epileptic attack disorder. The swoon was seen as a cut-off phenomenon: the abreactive attack as a kind of acting out the memory of the abuse, part of a post-traumatic stress disorder. Both may respond to counselling for the abuse although it is too early to be certain, and there is a risk of further episodes of the non-epileptic attack disorder during periods of stress. Some patients with epilepsy, however, also had a history of previous sexual abuse: in some the stress of the abuse may have precipitated the epileptic seizures.
Seizure behaviour in a patient with post-traumatic stress disorder following rape. Notes on the aetiology of 'pseudoseizures'.
A patient is described who began to have paroxysmal convulsive behaviour, followed by a post-ictal aggression, which was initially diagnosed and treated as epilepsy. The behaviour began after the patient was raped. She had many of the symptoms of post-traumatic stress disorder. It is suggested that the paroxysmal behaviour was an 'acting out' of intrusive and vivid memories of the rape, so called 'flashbacks'. Because the rape had occurred comparatively recently and the events that occurred during the rape were known, it was easy, in this particular patient, to understand the relationship between the previous trauma and the paroxysmal behaviour. The case throws some light on the relationship between similar paroxysmal behaviour in the victims of child sexual abuse and the trauma they had suffered and explains why they behave in the way that they do.
Epilepsy services. What people need, what they want, what they get.
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The effects of two anti-vertigo drugs (betahistine and prochlorperazine) on driving skills.
1. The effects of betahistine 72 mg three times daily, prochlorperazine 5 mg three times daily and placebo taken for 3 days before testing were compared on two actual driving tasks (weaving and gap estimation) and two psychomotor tasks (reaction time and kinetic visual acuity) in normal subjects in a double-blind prospectively randomised cross-over study. 2. The psychomotor effects of betahistine could not be distinguished from those of placebo. 3. Prochlorperazine impaired driving performance causing increased carelessness and slowing on the weaving test. 4. There was little subjective appreciation of impairment whilst taking prochlorperazine.
Human safety of lamotrigine.
The clinical safety of lamotrigine (LTG), assessed in four completed randomized, double-blind, placebo-controlled crossover trials and an interim analysis of 27 12-month open studies, is discussed. LTG was added to existing antiepileptic drugs (AEDs) of adult patients with refractory epilepsy, using a twice-daily regimen. In the pooled data from the four double-blind studies (n = 92), the incidence of adverse experiences with LTG and placebo did not differ significantly. Two patients were withdrawn on LTG due to adverse experiences (one rash, one nausea and vomiting). In the open studies (pooled data; n = 572) the most commonly reported adverse experiences were dizziness, diplopia, somnolence, headache, ataxia, and asthenia (10-14% incidence). Forty-nine patients (8.6%) were withdrawn with adverse events, most commonly for rash (2.3%). No patients were withdrawn from any of the studies with physical, neurological, or ECG abnormalities thought attributable to LTG treatment. Laboratory measures, vital signs, and weight did not show any consistent changes of clinical significance, and no significant changes in plasma concentrations of concomitant AEDs after the addition of LTG were observed.
Pseudoseizures: seizures that are not epilepsy.
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Hypomania following complex partial seizures. A report of three cases.
Depressive disorders are commonly found among selected groups of patients with epilepsy, but hypomania is seldom seen. Three cases of hypomania seen at a unit specialising in epilepsy are presented. The cases are of interest because of their association with recent seizures, and location in the non-dominant temporal lobe.
Patterns of psychiatric morbidity in a genito-urinary clinic. A validation of the Hospital Anxiety Depression scale (HAD).
The prevalence of psychiatric disorder (by DSM-III criteria) in a population attending a genito-urinary clinic was found to be 31%. The performance of the Hospital Anxiety Depression (HAD) scale as a screening questionnaire for psychiatric disorder was assessed. Case definition by a score of 8 or more on either of the anxiety or depressive subscales produced optimal results, giving sensitivities of 82% and 70%, and specificities of 94% and 68%, for depressive and anxiety disorders respectively.
Response of laryngeal and tracheo-bronchial surface lining to inhaled cigarette smoke in normal and vitamin A-deficient rats: a scanning electron microscopic study.
The effects on surface morphology of airway epithelium of cigarette smoke (CS) inhalation alone (experiments one and two) or of CS in combination with hypovitaminosis A (experiment two) was investigated using specific pathogen free rats. Eight morphologically distinct cell types were distinguished overall. Apart from atypical squamous lesions, each of the other cell types could be found in varying proportions in all experimental groups. CS alone caused an increase in the frequency with which intra-lumenal mucus was seen and an increase in the occurrence of secretory cells of types IV (i.e., 'merocrine') and V (i.e., 'apocrine'). In experiment one, the area of trachea covered by cilia as determined by point counting increased significantly (P less than 0.01). Hypovitaminosis A was induced by lowering the dietary intake of vitamin A to a minimum, defined level. Rats showed an approximately 75% decrease in plasma retinol levels and a 95-100% decrease in hepatic stores of vitamin A. At this level, hypovitaminosis A alone had no significant effect on airway epithelial morphology. Foci of squamous metaplasia (squamous cells of type VIIIa) were found in all groups but extensive squamous metaplasia of the larynx and squamous lesions of atypical appearance (type VIIIb) were found only in the vitamin deficient group exposed to CS. The results suggest the synergistic effects of reduced vitamin A and CS may be important in the induction of atypical squamous changes which may predispose the airway to the development of squamous carcinoma.
The value of low speed, off-road driving tasks.
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Another opportunity to improve epilepsy services should not be lost.
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Effects of two antihistamine drugs on actual driving performance.
A double blind placebo controlled experiment was conducted measuring the effects of the centrally active antihistamine triprolidine and the peripherally acting antihistamine terfenadine on actual driving performance in a group of experienced women drivers. Triprolidine greatly impaired driving behaviour, whereas terfenadine did not. Triprolidine also impaired subjective and objective measures of mood and arousal, and despite an awareness that their driving was impaired while they were taking this agent subjects could not correct their performance. This study suggests that drivers who need antihistamine drugs should avoid those that act centrally.
Diazepam/beta-adrenoceptor antagonist interactions.
The effects of diazepam on the pharmacokinetics and pharmacodynamics of two lipophilic beta-adrenoceptor antagonists (propranolol and metoprolol) and a hydrophilic beta-adrenoceptor antagonist (atenolol) were compared in 12 subjects. Administration of propranolol and metoprolol produced small increases in the AUC0-8h for diazepam compared with placebo (P less than 0.05 for metoprolol). Atenolol had no significant effect on the AUC0-8h for diazepam. The increase in the AUC0-8h was accompanied by increases in the plasma concentrations of N-desmethyldiazepam. Diazepam had no significant effect on the pharmacokinetics of either propranolol or atenolol. The pharmacokinetic interaction could be attributed to inhibition of diazepam metabolism by the lipophilic beta-adrenoceptor antagonists. The pharmacodynamic studies showed that when compared with placebo or atenolol there was a significant impairment of kinetic visual acuity (KVA) when diazepam was co-administered with metoprolol. Although there was a significant correlation (P less than 0.02) between plasma concentrations of diazepam and impairment of KVA, the pharmacodynamic interactions may not be due solely to the small pharmacokinetic interaction observed.
Epilepsy: Questions and answers.
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Effects of beta blockade on driving.
During tests of driving performance and kinetic visual acuity (KVA) under the influence of antihypertensive drugs (methyldopa, propranolol, atenolol, and reserpine), a significant improvement in KVA was found with atenolol and deterioration in driving was found with methyldopa and reserpine. Further tests of subjective response using an analogue rating scale revealed an apparently clear anxiolytic effect of atenolol. This was a surprising result as this particular beta-blocking agent is said not to penetrate the brain tissue via the blood/brain barrier. Preliminary results of the effect of atenolol on sleep showed that it reduced the number of changes in level of sleep thereby making it more restful. Atenolol is, therefore, an interesting compound having obvious peripheral but no central effects, but can yet act as an anxiolytic agent and influence the quality of sleep.