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PubMed1985

Advances in the clinical development of antiepileptic drugs.

In this paper we describe advances in the clinical development of antiepileptic drugs as a function of the Antiepileptic Drug Development Program of the National Institute of Neurological and Communicative Disorders and Stroke. This program encompasses both the preclinical and clinical elements of drug development through the Anticonvulsant Screening Project, the Toxicology Project, and the support of controlled clinical trials of potential new drugs that emerge from these projects and promise to be more effective and less toxic than those currently available for the treatment of epilepsy.

Animals↗
PubMedDate not supplied

A survey approach for finding cases of epilepsy.

Identify persons with epilepsy by first looking for prescriptions for particular antiseizure drugs. Follow these prescriptions from the pharmacies to the physicians who wrote them for patients. Ask the physicians whether the patients have epilepsy. Finally, contact the patients who do have epilepsy to elicit information about the impact of that condition on their lives. With these steps, it may be possible to carry out successfully a probability survey of epilepsy in the United States population. To learn more about this approach, a field test was funded by the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) of the Public Health Service. From 1978 through 1982, the work was planned, carried out, and evaluated by Research Triangle Institute, Research Triangle Park, NC. Epilepsy is a sensitive topic to ask about in a survey. Also, the condition is sufficiently rare to render ordinary survey approaches inefficient. Even if rarity were not an issue, there would be the problem of response error because a person with epilepsy does not, as a rule, have much clinical information on his or her condition. Better information lies with the physician who provides the care, but many physicians are busy with their practices. Furthermore, their record systems are usually not designed for easy retrieval of information, unless the names of patients are available. In the survey approach considered here, the names of patients are obtained through a random sampling of prescriptions for antiseizure drugs. The field test was divided into three phases with special activities reserved for each. The most important problem confronted was how to safeguard the confidentiality of relationships between pharmacist and patient and between physician and patient.Special guidelines on confidentiality were put into effect for the data collection. These guidelines,however, contributed to serious problems of nonresponse-especially for physicians. This article provides a brief account of the field test, including a rationale for the survey strategy of finding cases of epilepsy through prescriptions for antiseizuredrugs.

Anticonvulsants↗
PubMed1985

Vestibular evaluation of infants and preschool children.

This article presents an updated summary of vestibular test modifications employed at the Boys Town National Institute for Communication Disorders in Children. In addition, we report the results of vestibular evaluations of 104 full-term and premature children (47 male and 57 female) ranging in age from 3 months to 6 years, including a group of postmeningitic patients. The evaluations utilized harmonic acceleration (HA). No age-related maturational differences in HA gain, phase, or symmetry for an 0.08 Hz screening frequency were found when full-term and premature infants were compared. Infrared video technology was adapted to provide continuous visual monitoring of head and eye position in the totally darkened test enclosure.

Caloric Tests↗
PubMed1986

A paying health promotion clinic: combining client services and student learning.

Major societal changes over the past two decades have created the need for competent health care professionals able to provide high quality health care in a rapidly changing, highly technical society. To meet this goal, the University of Northern Colorado College of Health and Human Services prepares graduates in a unique multidisciplinary health promotion clinic. Department chairs along with clinic and faculty coordinators manage student-learning and client-service activities in this 9,000-square-foot, on-campus clinic. Income is generated through third-party payments and client fees from programs in nursing, nutrition, communication disorders, human rehabilitative services, and community health. Problems encountered in developing this clinic included staffing, physician consultation, fee assessment, faculty hesitancy, and health care competition. Positive outcomes were a more autonomous professional identity for students, clinic practice and research opportunities for faculty, and health promotion care for selected client groups.

Allied Health Personnel↗
PubMed1985

The Antiepileptic Drug Development Program: an example of government-industry collaboration.

By collaborating with the pharmaceutical industry in key areas of drug development, the ADD Program of the Epilepsy Branch, National Institute of Neurological and Communicative Disorders and Stroke, has responded to the need for more effective and less toxic antiepileptic drugs than those currently available. The program screens large numbers of compounds for anticonvulsant activity, conducts toxicology studies, and sponsors clinical trials of promising new drugs for the treatment of epilepsy. This collaboration with the pharmaceutical industry is providing a valuable model for a shared drug development program.

Anticonvulsants↗
PubMed1979

Sequential analysis of spontaneous abortion. II. Collaborative study data show that gravidity determines a very substantial rise in risk.

Evidence from more than 14,000 reproductive histories in the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke indicates that the risk of spontaneous abortion increases considerably with gravidity. Maternal age, memory errors, and sampling bias related to recurrence risk do not account for the trend. Clustering, or tendency for abortions to follow one another, occurs in histories which include live births.

Abortion, Spontaneous↗
PubMed1979

[Emancipatory rehabilitation in logopedics -- comments from the medico-rehabilitative viewpoint (author's transl)].

In the Federal Republic of Germany speech disturbances, as sub-group of communication disorders, are treated by two professional groups: a) free practising logopedists who chose their team themselves as well as logopedists who are working in a clinic team and b) "Sprachheilpädagogen" (speech therapists) working at special education facilities. Irrespective of the age of the patient, treatment by logopedists is paid by the health insurance funds; special education therapy is paid by the financially responsible school agencies. The basis of the disease is not a deviation but a disturbance of the central nervous system which can be determined by medical, phoniatric-neurological diagnostic means.

Germany, West↗
PubMed1983

Antiepileptic drug development program.

The Epilepsy Branch of the National Institute of Neurological and Communicative Disorders and Stroke has responded to the need for new, more effective, and less toxic antiepileptic drugs by cooperating with pharmaceutical companies in key areas of development. The ADD Program screens large numbers of compounds for anticonvulsant activity in appropriate animal models and sponsors clinical trials of promising new drugs for the treatment of epilepsy. The use of investigative techniques developed since the late 1960s allows documentation of seizure type and seizure frequency for maximal objectivity of clinical trial data.

Anticonvulsants↗
PubMedDate not supplied

Findings from a major U.S. survey of persons hospitalized with head injuries.

In 1974, work began on the first national survey of head and spinal cord injuries in the United States. The survey was a project of the National Institute of Neurological and Communicative Disorders and Stroke of the Public Health Service. This article presents highlights of the survey, particularly the findings about head injuries (that is, brain injuries). The survey population consisted of people admitted to U.S. hospitals as inpatients between January 1, 1970, and December 31, 1974. To be medically eligible, patients must have experienced physical injury (except birth trauma) caused by an external, mechanical force. Probability sampling was used in a three-stage plan to select appropriate hospital records. Findings of the head and spinal cord injury survey follow: Of all age groups, 15- to 24-year-olds had the highest rate of head injuries. Males had a rate of head injuries more than twice that of females. Head injuries occurred most often on Fridays, Saturdays, and Sundays. The chief cause of head injuries was motor vehicle accidents.

Accidents, Traffic↗
PubMed1982

Youngsters who stutter: diagnosis, parent counseling, and referral.

The purpose of this paper is to present clinical considerations regarding the speaking behavior, nature, and environment of young children who stutter. The speech of these children contains more within-word speech disfluencies (sound/syllable repetitions, sound prolongations, and within-word pauses) than that of their normally fluent peers. Although the physical, mental, social, psychological, and communicative nature of these children is not grossly different than that of unaffected children, some youngsters who stutter do exhibit subtle delays or deviancies in speech sound articulation, expressive language, and fine/gross motor coordination skills. The young stutterer's environment is as variable as that of the average child. Careful observation reveals subtle, and some not so subtle, parental attitudes which seem to foster the child's belief that speaking is a difficult task, requiring mental and physical effort, and that it must be produced precisely, quickly, and maturely. Information is provided to clinicians working with children between 2 and 6 years of age (the time period when stuttering usually begins) which should assist in objective identification of childhood stuttering, recognition of those symptoms which most strongly suggest referral, as well as an understanding of basic "facts" about this most complex of communication disorders.

Child↗
PubMed1980

Blink reflex: review of methodology and its application to patients with stroke syndromes.

The blink reflex may be elicited in the orbicularis oculi following electrical stimulus to the periorbital regions. It consists of a direct early component (R1) and a late component (R2) which is both direct and consensual. The amplitudes of R1 and R2 are reduced and the latencies normal in patients with lesions affecting the parietal lobe of the cerebral hemisphere. The blink reflex may well include tactile contributions from the parietal lobe. The latency of R1 may be prolonged by injuries of the pons and that of R2 by lateral medullary lesions. Blink reflexes may help to distinguish bulbar from pseudobulbar lesions and to estimate the response to therapy in patients with communication disorders.

Cerebrovascular Disorders↗
PubMed1994

[Rehabilitation of hemiplegia patients].

The indications for a specific rehabilitation training programme for elderly stroke patients are discussed. Special symptomatology, such as hemi-anesthesia as a result of a damaged perceptual process, apraxia including apraxia of dressing, communication disorders and affective disorders are presented. The measures to be taken for effective rehabilitation in hospital, in an institution for the elderly or in the home care situation are indicated. In addition, the physician has to have marked ability for empathic comportment.

Activities of Daily Living↗
PubMed1995

The interuncal distance in Alzheimer disease and age-associated memory impairment.

PURPOSE: To examine the value of measurement of the interuncal distance in the diagnosis of mild to moderate Alzheimer disease. METHODS: We measured interuncal distance from coronal MR scans acquired on a 1.5-T imager. We estimated interuncal distance from a total of 141 subjects: 54 patients diagnosed according to the National Institute of Neurological and Communicative Disorders and the Alzheimer's Disease and Related Disorders Association criteria of probable Alzheimer disease, 40 subjects fulfilling the National Institute of Mental Health criteria of age-associated memory impairment, 27 healthy cognitively normal older control subjects, and 20 control subjects younger than 50 years of age. For comparison we normalized interuncal distance for a horizontal line drawn through the inner cranium at the level of the uncus (interuncal distance/intracranial width ratio), for the brain area (interuncal distance/brain area) and for the intracranial area (interuncal distance/intracranial area). RESULTS: The standard interuncal distance and the interuncal distance/intracranial width differed between the young control subjects and the other groups, but did not differ among the control, age-associated memory impairment, and Alzheimer disease groups. The Alzheimer disease group had significantly greater interuncal distance/intracranial area and interuncal distance/brain area compared with age-matched controls. A considerable overlap was found, however, in the values of patients with Alzheimer disease and control subjects. The cutoff point of 30 mm for interuncal distance yielded 37% sensitivity and 72% specificity to distinguish patients with Alzheimer disease from nondemented elderly subjects. Interuncal distance was not significantly related to the clinical severity of Alzheimer disease as assessed by Clinical Dementia Rating Scale and Mini-Mental Status Examination. Instead, there was a strong correlation between standard and normalized interuncal distance and age in the whole study population and in nondemented subjects. CONCLUSIONS: Our results showed that in a series of 54 patients with mild to moderate Alzheimer disease, interuncal distance was not a reliable diagnostic tool. The study also confirmed the strong age dependence for interuncal distance.

Adult↗
PubMed1995

Nosology of deafness.

It is estimated that about one half of all congenital deafness and/or hearing impairment is inherited and that approximately one third of this communicative disorder is associated with syndromic abnormalities. The remainder of inherited deafness occurs as an isolated entity, independent of alterations in physical status or any disease process. This latter group typically presents with no clinical signs or symptoms or other dysmorphic stigmata that might help in the early identification of hearing loss. As contemporary advances in genetic testing and therapy emerge, there is an ever-increasing opportunity to provide improved diagnosis and counseling to those with inherited disorders. Over the past 3 decades, there have been several distinct categorical systems introduced to define deafness. Most often, the nosology of deafness is described by either origin, onset, degree and type of severity, and/or structural pathology. Therefore, understanding the cause and nature of hearing loss is the first measure in the accurate diagnosis and management of patient care. This article describes several classification schemata, citing examples of numerous congenital syndromes and other disorders that contribute to deafness.

Chromosome Aberrations↗
PubMed1995

Alzheimer and vascular dementias and driving. A prospective road and laboratory study.

OBJECTIVE: To characterize on-the-road, behind-the-wheel driving abilities and related laboratory performances of subjects with mild Alzheimer's disease (AD) and vascular dementia. DESIGN: Prospective, experimental study involving two mild dementia and three age and health control groups. Road test reliability and validity were assessed. SETTING: Greater western Los Angeles. Subjects were enrolled from the community by referral and from the Veterans Affairs dementia and diabetes clinics. PARTICIPANTS: Eighty-seven driving subjects were enrolled; 83 completed the study. A sample of eligible dementia clinic subjects consisting of 15 mild AD patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association probable AD criteria, while 12 met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition and Hachinski diagnostic criteria for multi-infarct dementia (vascular dementia). Clinic control subjects consisted of 15 age-matched patients with diabetes and without a history of stroke or dementia. Community controls consisted of 26 healthy, age-matched, older subjects (> 60 years) and 16 young subjects (20 to 35 years). MAIN OUTCOME MEASURES: Drive score from the Sepulveda (Calif) road test and laboratory measures of attention, perception, and memory. RESULTS: The drive scores in the mild AD group (mean, 22.1; SD, 3.8) and in the vascular dementia group (mean, 24.0; SD, 7.8) differed significantly (P < .001 studentized range test) from the drive scores in the diabetic control group (mean, 31.5; SD, 3.9), the older control group (mean, 32.6; SD, 2.8), and the young control group (mean, 33.6; SD, 3.2). Drive score among the three control groups did not vary significantly. Short-term memory (Sternberg), visual tracking, and Folstein Mini-Mental State Examination scores correlated best with drive score, with a cumulative R2 of 0.68. Drive score and number of collisions and moving violations per 1000 miles driven were negatively correlated (r = -0.38; P < .02). CONCLUSIONS: Based on this study, type and degree of cognitive impairment are better predictors of driving skills than age or medical diagnosis per se. Specific testing protocols for drivers with potential cognitive impairment may detect unsafe drivers more effectively than using age or medical diagnosis alone as criteria for license restriction or revocation.

Adult↗
PubMed1994

Prevalence of disabling conditions in a rural northern Thai community: a survey conducted by village health communicators.

This report presents a survey of disabling conditions conducted by village health communicators (VHCs) in 1989 in a rural northern Thai community. The disabled were first identified by a VHC and then examined clinically and socially by a health care team both to confirm the clinical diagnosis and to formulate an appropriate treatment plan. The overall prevalence rate of disabled persons was 6.3/1,000 population. The prevalence rate was higher for males than females and increased with age. Locomotor disability (48.8%) was the most commonly identified disabling condition, with visual disability (27.8%) the next most common. Communication disorders, mental retardation, and psychosis constituted the remaining 23.4%. Of the locomotor disabilities, the major disabling conditions were poliomyelitis, congenital malformations, traumatic amputations, and cerebral palsy. Unoperated cataract accounted for 72.0% of all cases with visual disabilities. While the true magnitude of the disability problem may be somewhat understated, the data reported in this study clearly reveal that there are many persons with untreated disabling conditions in rural communities, and that a significant number of them can benefit from medical treatment and rehabilitation. A survey utilizing VHCs may be helpful to identify the disabled in rural communities.

Adolescent↗
PubMed1994

Overview of seizures.

Epilepsy is a chronic disorder characterized by recurrent unprovoked epileptic seizures. Not all epileptic seizures indicate the existence of an epileptic disorder; many represent a natural response of the normal brain to transient noxious insults that are not likely to be repeated (reactive seizures). Not only is it important to distinguish conditions associated with these relatively benign epileptic events from epilepsy, but also it is important to recognize the many types of epileptic seizures and many types of epilepsy, reflecting different underlying anatomic and pathophysiologic substrates, which determine therapy and prognosis. Acute care for an epileptic seizure, therefore, includes search for an underlying treatable cause and protection against recurrence, if necessary. Neurologic consultation in the emergency department can help avoid unnecessary diagnostic procedures and treatments, particularly in patients with reactive seizures and established epileptic disorders. Communication with the patient's continuing care physician is an essential part of the emergency department management plan.

Diagnosis, Differential↗