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Biomedical subjects

D L Coulter

Publications and source records attributed to D L Coulter.

At least 19 recordsLinked to original sources
PubMed1992

The persistent vegetative state in children: report of the Child Neurology Society Ethics Committee.

Increasing concern about children in a persistent vegetative state (PVS) prompted a survey of members of the Child Neurology Society regarding aspects of the diagnosis and management of this disorder. Major findings of those responding to this survey (26% response rate) were as follows: (1) 93% believed that a diagnosis of PVS can be made in children, but only 16% believed that this applied to infants younger than 2 months and 70% in the 2-month to 2-year group; (2) a period of 3 to 6 months was believed to be the minimum observation period required before a diagnosis of PVS could be made; (3) 86% believed that the age of the patient would affect the duration of time needed to make the diagnosis of PVS; (4) 78% thought a diagnosis of PVS could be made in children with severe congenital brain malformations; (5) 75% believed that neurodiagnostic studies would be of value and supportive of the clinical diagnosis of PVS; (6) members' opinions as to the average life expectancy (in years) for the following age groups after the patients were considered vegetative were: newborn to 2 months, 4.1; 2 months to 2 years, 5.5; 2 to 7 years, 7.3; and more than 7 years, 7.4; (7) 20% believed that infants and children in a PVS experience pain and suffering; and (8) 75% "never" withhold fluid and nutrition from infants and children in a PVS and 28% "always" give medication for pain and suffering.(ABSTRACT TRUNCATED AT 250 WORDS)

Advisory Committees↗
PubMed1992

An ecology of prevention for the future.

The field of mental retardation is being changed by a paradigm shift in how mental retardation is conceptualized and in how services are provided. This new way of thinking is reflected in the 1992 AAMR definition of what mental retardation is (Luckasson et al., 1992). Prevention efforts must also reflect this new way of thinking, which focuses on the interaction between individuals and their environment. In this paper, the stage was set for adoption of a new vision of prevention that incorporates an ecological approach to understanding the causation of mental retardation. The articles in this symposium were reviewed and their relevance to this new vision discussed. A comprehensive, coordinated, and integrated prevention program is needed that includes new strategies addressing a variety of personal, social, and environmental risk factors and on the interactions among them.

Adolescent↗
PubMed1991

Carnitine, valproate, and toxicity.

Carnitine is an important nutrient that is present in the diet (particularly in meat and dairy products) and is synthesized from dietary amino acids. It functions to assist long-chain fatty acid metabolism and to regulate the ratio of free coenzyme A to acylcoenzyme A in the mitochondrion. Carnitine deficiency occurs in primary inborn errors of metabolism, in nutritional deficiency, and in various other disorders including antiepileptic drug therapy. Valproate therapy is often associated with decreased carnitine levels and occasionally with true carnitine deficiency. Some experimental and clinical evidence links valproate-induced carnitine deficiency with hepatotoxicity, but this evidence is limited and inconclusive. Carnitine supplementation has been useful in some studies, but these data are also limited. Young children with neurologic disabilities taking multiple antiepileptic drugs may have the greatest risk for carnitine deficiency. Measurement of carnitine levels appears warranted in these patients and in patients with symptoms and signs of possible carnitine deficiency.

Carnitine↗
PubMed1988

Withdrawal of barbiturate anticonvulsant drugs: prospective controlled study.

A barbiturate (phenobarbital or primidone) was withdrawn over a period of 3 months from 25 institutionalized residents, all of whom had had three seizures or less in the past 6 months and were maintained on a nonsedating drug (phenytoin, carbamazepine, or valproic acid). Results were compared with a matched comparison group maintained on both drugs. Subjects withdrawn from primidone, but not those withdrawn from phenobarbital, had increased seizure frequency, probably due to withdrawal. After 14 months, seizure-free subjects withdrawn from barbiturates were no more likely to have had seizures than were comparison subjects. Barbiturates appear to be unnecessary and may be withdrawn.

Adolescent↗
PubMed1986

Continuous infantile spasms as a form of status epilepticus.

An infant with congenital cytomegalovirus infection first developed seizures at six weeks of age. At 3 1/2 months of age, he developed continuous infantile spasms that lasted for more than an hour. This episode of status epilepticus was terminated by intravenous lorazepam and paraldehyde, and seizures were subsequently controlled for seven months by adrenocorticotropic hormone (ACTH), valproic acid, and phenobarbital. This case demonstrates that continuous infantile spasms may occur as a unique form of status epilepticus in young infants.

Cytomegalovirus Infections↗
PubMed1985

Information needs of parents of children with epilepsy.

We tested the hypothesis that parents of children with epilepsy may have unmet information needs because their physicians do not fully appreciate what those needs are. Twenty-four parents ranked 60 items of possible concern to them that reflected medical, school, socialization, personality, and family relationship issues. Five neurologists who treat children with epilepsy ranked the same 60 items to predict parental concerns. Ranking was performed using the Q-sort technique. Parents' and physicians' rankings were compared using a two-tailed Mann-Whitney U test. There was a statistically significant difference between the two groups on 17 of the 60 items. The physicians tended to overestimate the importance of medical concerns and underestimate the importance of psychosocial concerns. Poor communication may occur when physicians do not recognize parental concerns or parental levels of understanding of health and illness.

Adolescent↗
PubMed1984

Partial seizures with apnea and bradycardia.

Seizures developed in an infant who had apnea and severe bradycardia. Split-screen video-EEG monitoring of three such seizures showed that a left temporal paroxysmal discharge preceded the apnea. Partial seizures should be included in the differential diagnosis of infants with attacks of apnea and bradycardia.

Apnea↗
PubMed1983

Kearns-Sayre syndrome with reduced plasma and cerebrospinal fluid folate.

A young woman with Kearns-Sayre syndrome and progressive central nervous system deterioration over 15 years had decreased plasma and cerebrospinal fluid folate levels while receiving phenytoin for a seizure disorder. A muscle biopsy showed a "ragged red fiber" myopathy with reduced muscle carnitine and mitochondrial enzymes. Computed tomographic brain scans showed cerebral white matter hypodensities and bilateral calcification of the basal ganglia. The mechanism for the folate deficiency and altered ratio of plasma to cerebrospinal fluid folate is unknown, but the deficiency may be responsive to replacement therapy.

Adolescent↗
PubMed1983

Capsular stroke as a cause of hemiplegia in infancy.

Small, deep lesions of the internal capsule are an uncommon cause of infantile hemiplegia. We report the clinical and radiographic findings of three children with hemiplegia with capsular lesions. Although the etiology of capsular stroke in these children remains uncertain, neither hypertension, coagulopathy, nor vascular malformation was an important factor.

Cerebrovascular Disorders↗