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D C Reutens

Publications and source records attributed to D C Reutens.

53 records · Page 3Linked to original sources
PubMed1993

Localised neuronal migration disorder and intractable epilepsy: a prenatal vascular aetiology.

Localised neuronal heterotopias are an increasingly recognised cause of intractable focal epilepsies. The aetiology of these circumscribed disorders of neuronal migration is often unknown although in some instances proximity to areas of prenatal infarction suggests that severe ischaemia was responsible. A patient is described with intractable complex partial seizures associated with heterotopic grey matter and cerebral hypoplasia confined to the territory of the left posterior cerebral artery; the left hippocampus was spared. Angiography showed a normal left anterior choroidal artery but a hypoplastic left posterior cerebral artery, implicating prenatal ischaemia without frank infarction as the aetiology of the malformation.

Adult↗
PubMed1993

Cortical hyperexcitability in progressive myoclonus epilepsy: a study with transcranial magnetic stimulation.

In progressive myoclonus epilepsy (PME), responses to afferent input are frequently abnormal. It is unclear whether the abnormality lies at the cortical, subcortical, or segmental level. To obtain evidence for an exaggerated effect on motor cortical excitability, we used peripheral nerve and transcranial magnetic stimulation in controls and subjects with idiopathic generalized epilepsy and PME. Mean threshold intensity was higher in those with idiopathic generalized epilepsy and PME than in controls, probably as a result of anticonvulsant treatment. A long-latency response to peripheral stimulation and an exaggerated facilitatory effect of peripheral stimulation on the motor evoked potential was present in subjects with PME. Latency differences between the late responses in the upper and lower limbs provided evidence against a segmental reflex and implicated rapidly conducting fibers in the spinal cord. Both the late response and the facilitatory effect had onset latencies consistent with a transcortical pathway, suggesting an exaggerated effect of afferent input on motor cortical excitability in PME.

Adaptation, Physiological↗
PubMed1992

HLA-DR2 negative narcolepsy in Australian Caucasians: clinical features, serology and sequence specific oligonucleotide typing.

An almost invariable association with HLA-DR2 and DQw1 has previously been reported in Japanese and caucasian narcoleptics. We performed HLA typing in 18 Australian narcoleptics using serological techniques and sequence specific oligonucleotide probes. HLA-DQw1 was present in 15 patients and DR2 in 12; 3 patients with cataplectic narcolepsy were DR2-negative. The serological haplotype most strongly associated with narcolepsy was DRw15 (a subtype of DR2), DQw1. DRw15-positive patients were positive for the alleles DRB1*1501 and DQB1*0602 defined with oligonucleotide probes. We conclude that the association of narcolepsy with DR2 and DQw1 is not as strong as previously reported and the absence of DR2 or DQw1 does not preclude the diagnosis of classical narcolepsy, at least in caucasians. Secondly, DR2-positive narcoleptics possess characteristic serological subtypes and alleles defined with oligonucleotide probes that are also found in normals. Thirdly, the occurrence of DR2-negative cataplectic narcoleptics points to the existence of more than one narcolepsy susceptibility gene.

Adult↗
PubMed1992

Dystonia, clinical lateralization, and regional blood flow changes in temporal lobe seizures.

We analyzed the lateralizing value of ictal dystonia and head-turning in temporal lobe epilepsy, and sought the biologic basis of these clinical signs by studying the regional changes in perfusion with ictal single-photon emission computed tomography (SPECT). We identified unilateral temporal lobe epilepsy in 40 of 42 patients undergoing evaluation for temporal lobe surgery, and with ictal SPECT all 40 showed striking hyperperfusion of the epileptogenic temporal lobe. Twenty-five of the 40 patients showed unilateral or predominantly unilateral upper limb dystonia, which was opposite the epileptic temporal lobe in all cases. Analysis of regional count ratios in cases with ictal dystonia, compared with those without, showed significant changes only in the basal ganglia. Specifically, we found that ictal dystonia was associated with a relative increase in perfusion of the basal ganglia opposite the dystonic limb. Although we found 26 cases with head-turning, the sign was of no lateralizing value, even when only those with major or "tonic" versions (n = 11) were analyzed. Slight increases in cortical blood flow on the side opposite the direction of version were associated with head-turning, irrespective of the side of seizure focus. In clinical practice, ictal SPECT is a highly accurate aid in the lateralization of temporal lobe foci, in addition to providing a new method to investigate the pathophysiology of clinical signs in focal seizures.

Adolescent↗
PubMed1991

Neuroleptic malignant syndrome complicating levodopa withdrawal.

OBJECTIVE: To describe a case of neuroleptic malignant syndrome (NMS) resulting from withdrawal of low-dose levodopa therapy for mild Parkinson's disease. CLINICAL FEATURES: Treatment with levodopa, 50 mg, and benserazide, 12.5 mg, three times a day was withdrawn from a 76-year-old woman with mild Parkinson's disease because she was experiencing intermittent confusion. Fever (38.5 degrees C), tachycardia, increased confusion, severe rigidity and generalised stimulus-sensitive myoclonus developed after 12 hours. The creatine kinase level rose to 2058 U/L. INTERVENTION AND OUTCOME: The fever abated with reintroduction of levodopa. Rigidity was slow to resolve and required additional treatment with dantrolene sodium. CONCLUSION: NMS may be precipitated by withdrawal of relatively low doses of levodopa, even in patients with mild Parkinson's disease. Hyperthermia and rigidity in NMS may result from involvement of separate central dopaminergic pathways.

Aged↗
PubMed1991

Is intravenous lidocaine clinically effective in acute migraine?

We performed a prospective, randomized, double-blind, placebo-controlled trial of intravenous lidocaine (1 mg/kg) in the treatment of acute migraine. Thirteen subjects were randomly allocated to receive intravenous lidocaine and 12 received intravenous normal saline. Subjects scored the intensity of headache and nausea on separate visual analogue scales before the injection and at 10 and 20 min after injection. At 20 min, the mean pain intensity score was 80% of initial intensity in the lidocaine group and 82% in the placebo group. The difference was not statistically significant; at 20 min, the 95% confidence interval for the difference between the two groups in mean percentage of initial pain score was 2 +/- 29%. At the dose studied, intravenous lidocaine has, at best, only a modest effect in acute migraine.

Acute Disease↗
PubMed1990

Triphasic waves in accidental hypothermia.

Triphasic waves occur in a variety of metabolic, toxic and diffuse encephalopathies. We describe an elderly patient in whom triphasic waves accompanied moderately severe accidental hypothermia and disappeared on rewarming.

Aged↗
PubMed1990

Burning oral and mid-facial pain in ventral pontine infarction.

The symptom of burning orofacial pain may help to identify the site of ischaemia in otherwise pure motor strokes resulting from infarction of the ventral pons. A patient with hemiplegia due to ventral pontine infarction, in whom burning oral and mid-facial pain was a prominent initial symptom, is described. Similar pain preceded transient episodes of the 'locked-in' state. Awareness of this herald symptom may permit early recognition and careful monitoring of patients at risk of progressing to the 'locked-in' state.

Cerebral Infarction↗
PubMed1989

Factors influencing the yield of cranial CT scanning in a private neurological practice.

A prospective study was performed to evaluate the yield of cranial CT scanning in 164 patients referred from a private neurological practice between 1986 and 1988. An over all rate of scan abnormality of 19% was noted. The most common presenting symptoms were headache (51) and seizure disorder (36) and the rates of scan abnormality in these disorders were 15% and 25%, respectively. The yield of CT scanning in patients with headache may be increased by taking age, sex and symptom duration into account, abnormalities being significantly more likely in males, those aged over 40 years and those with headache durations shorter than one month. Those with both symptoms and signs of a structural lesion were more likely to have abnormal scans than those with either symptoms alone or signs alone, both in the group as a whole and in the subgroup with headaches. The predictive value of symptoms suggestive of a structural lesion was influenced by age, sex and the presenting symptom. The yield was low in young females with headache and symptoms suggesting a structural lesion. Such symptoms had a higher predictive value for scan abnormality in patients with seizure disorder than in those with headache. Contrast administration demonstrated a low yield of lesions not seen on pre-contrast scans.

Adult↗
PubMed1986

Morphology of bronchogenic carcinoma in workers formerly exposed to crocidolite at Wittenoom Gorge in Western Australia.

Cytology and histology material from 46 bronchogenic carcinomas occurring in ex-workers from the Wittenoom crocidolite mine and mill in Western Australia and a matched random sample of 234 other bronchogenic carcinomas occurring in Western Australia over the same period were reviewed by a single histopathologist without knowledge of asbestos exposure status. Squamous-cell carcinomas formed 45.7% of the cancers in the asbestos-exposed group but only 32.5% of the cancers in the comparison group. This difference could not be explained by differences in smoking history between the two groups of lung cancer patients or in the type of histopathological material available for review. The excess of squamous-cell cancers was observed in subjects both with and without parenchymal asbestosis.

Adult↗
PubMedDate not supplied

Validation of a questionnaire for clinical seizure diagnosis.

A detailed questionnaire has been devised for diagnosis of seizure type. It is suitable for administration by trained interviewers, either directly or by telephone. A comparison of physician-based and questionnaire-based diagnoses showed almost perfect agreement in classification of patients into those with seizures of either generalized or focal origin. Substantial to almost-perfect agreement was reached in diagnosis of patients with most individual seizure types. Disagreement in differentiation between simple and complex partial seizures (CPS) probably reflects the limitations of the clinical method rather than of the questionnaire itself. The questionnaire should be of value in large-scaled clinical and epidemiologic studies.

Adolescent↗
PubMedDate not supplied

Corpus callosotomy for intractable epilepsy: seizure outcome and prognostic factors.

We reviewed the outcome of corpus callosal section in 64 adult and pediatric patients to identify factors associated with a good outcome: 48% of patients had a favorable outcome for overall seizure frequency. Improvement was noted in several seizure types and was most likely for drop attacks, particularly in the setting of a unilateral focal cerebral lesion or a true generalized epilepsy of Lennox-Gastaut type. Poor outcomes for drop attacks were more likely if there was associated severe intellectual handicap or bilateral independent spikes on interictal EEG. Complex partial seizures (CPS), most commonly of frontal lobe origin, also responded favorably. The complications of callosal section were usually mild and transient. New focal seizures occurred in only 2 patients and were not as frequent or disabling as preoperative seizures types. A worthwhile improvement in seizure outcome was achieved by completion of the callosotomy in 6 of 10 patients with unsatisfactory results from anterior callosotomy.

Adolescent↗