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Biomedical subjects

D W Dunn

Publications and source records attributed to D W Dunn.

At least 19 recordsLinked to original sources
PubMed1998

Academic achievement in children with epilepsy or asthma.

The purposes of the study were to compare academic achievement between children with epilepsy and those with asthma and to identify child perception, school adaptive functioning, and condition severity factors related to academic achievement. Subjects were 225 children (117 with epilepsy and 108 with asthma) aged between 8 and 12 years. Academic achievement was measured using school-administered group tests. Self-report questionnaires were used to measure child attitudes and school self-concept. Teachers rated school adaptive functioning. Data were analyzed using ANCOVA and multiple regression. Children with epilepsy had significantly lower achievement scores than children with asthma. Boys with severe epilepsy were most at risk for underachievement. Factors related to poor academic achievement in both samples were: high condition severity, negative attitudes, and lower school adaptive functioning scores. Less variance was accounted for in the model for epilepsy (R2=0.25) than for asthma (R2=0.36). Boys with high seizure severity were most at risk for achievement-related problems. Future research in epilepsy should consider additional factors in the model predicting academic achievement.

Asthma↗
PubMed1997

Behaviour problems in children with new-onset epilepsy.

Behaviour problems are common in children with epilepsy and it is not known when these problems begin. Some suggest that behaviour problems are caused by a neurological condition that also causes the seizures. Behaviour problems were investigated in 42 youths (23 girls and 19 boys) over a 4-month period beginning at the time of the initial seizure. Subjects were aged 4-15 years (mean, M = 8.4). Approximately 57% had partial seizure(s) and 43% had generalized seizure(s). The large majority (71%) were diagnosed with epilepsy. As a part of a larger study, parents rated their children's behaviour on the Child Behaviour Checklist immediately prior to the first seizure (time 1), and at 4 months after the first seizure (time 2). Seizure severity was rated as follows: high = 20%, moderate = 39%, and low = 41%. At time 1, 24% already had behaviour problems. Behaviour problems significantly decreased from time 1 to time 2 (P < 0.001) for the whole group. Within the epilepsy group (n = 40), differences were found in behaviour problems based on seizure severity from time 1 to time 2 as follows: low, time 1: M = 55, time 2: M = 45; moderate, time 1: M = 55, time 2: M = 51; and high, time 1: M = 61, time 2: M = 55. Results indicate that children should be assessed for behaviour problems at the time of the first seizure.

Adaptation, Psychological↗
PubMed1996

Adolescents with active or inactive epilepsy or asthma: a comparison of quality of life.

PURPOSE: We compared quality of life (QOL) in youth with inactive or active epilepsy with that of a similar sample of youth with asthma. We explored 19 different dimensions in three domains (psychological, social, and school) and also determined differences related to illness severity and gender. METHODS: Subjects were 228 adolescents (117 with epilepsy and 111 with asthma). Data were collected from clinic records and from the adolescents, their mothers, and their teachers through questionnaires and structured interviews. Data were analyzed by analysis of covariance. RESULTS: The analysis with all 19 QOL variables indicated a significant difference between the total asthma and the total epilepsy samples (multivariate F = 3.36, p = 0.0001). Further evaluation reflected differences between the epilepsy group and the asthma group on 13 of the 19 QOL variables. When active and inactive epilepsy and asthma groups were compared, youth with active epilepsy were faring worse than all other groups in 10 areas. Moreover, youth with inactive epilepsy were faring worse than those with inactive asthma in four areas. Illness severity and sex differences were more strongly related to QOL in the epilepsy sample than in the asthma sample. Sex-severity interactions suggested that girls with high seizure severity were most at risk for QOL problems. CONCLUSIONS: Youth with active epilepsy generally had the poorest QOL. Severe seizures and female sex were associated with more problems. Sex-severity interactions should be explored in future research.

Adolescent↗
PubMed1991

Theophylline and status epilepticus in children.

We studied the role of theophylline on outcome of status epilepticus (SE) in children. During a two-year-period, 16 of 114 episodes of SE occurred in children receiving theophylline. At the onset of SE, theophylline blood levels were elevated in 8 episodes, and were therapeutic or subtherapeutic in 8 episodes. In the 8 episodes of SE with elevated theophylline levels, one child died and three suffered permanent new neurologic deficits. In the 8 episodes of SE with normal or low theophylline levels, only one child had a transient deficit. The occurrence of death or disability in 4 of 8 episodes of SE with elevated theophylline was considerably higher than the 23% incidence of death or persistent CNS deficit in the overall series of 114 episodes of SE. We conclude that theophylline, at toxic levels, is a significant factor in increased morbidity. We suspect that the hypoxia from the respiratory disorder for which theophylline was used, and the reduced cerebral blood flow known to occur with theophylline led to a failure to compensate for the increased cerebral metabolic rate of SE, thus increasing the risk of a poor outcome.

Adolescent↗
PubMed1991

Epidermal nevus syndrome: a neurologic variant with hemimegalencephaly, gyral malformation, mental retardation, seizures, and facial hemihypertrophy.

The epidermal nevus syndrome (ENS) is a sporadic neurocutaneous disorder that consists of epidermal nevi and congenital anomalies involving the brain and other systems. From among over 60 patients with ENS presenting with neurologic manifestations, we identified 17 who had hemimegalencephaly based on pathologic or radiologic studies. Associated brain and neurologic abnormalities included gyral malformations in 12 of 12, mental retardation in 13 of 14, seizures in 16 of 17 (including 9 with infantile spasms), and contralateral hemiparesis in 7 of 12. All had ipsilateral epidermal nevi of the head, and several had ipsilateral facial hemihypertrophy. We concluded that these abnormalities comprise a recognizable neurologic variant of ENS that we believe represents the full expression of primary brain involvement. Several patients also had evidence of acquired brain lesions such as infarcts, atrophy, porencephaly, and calcifications, which are best explained by prior ischemia or hemorrhage. Given repeated observations of blood vessel anomalies in ENS patients, we hypothesize that underlying vascular dysplasia predisposes to these acquired lesions. The same cause may be invoked to explain the wide variety of neurologic symptoms reported in ENS patients without hemimegalencephaly. While the cause of ENS remains unknown, several observations suggest a somatic mutation.

Bone and Bones↗
PubMed1990

Status epilepticus in infancy and childhood.

Status epilepticus implies a prolonged seizure or recurrent seizures with persistent decreased consciousness, lasting at least 30 minutes. Both convulsive and nonconvulsive forms exist, either of which may lead to death or additional neurologic deficit. Therapy involves careful supportive care plus some combination of benzodiazepines, phenytoin, or phenobarbital. The outcome depends first on the etiology and second on the rapidity with which seizures are controlled.

Anticonvulsants↗
PubMed1989

Magnetic resonance imaging evaluation of learning difficulties and incoordination in neurofibromatosis.

Areas of increased signal seen on magnetic resonance imaging (MRI) of the brain are frequently present in neurofibromatosis and are considered possible areas of dysplasia or heterotopias. Since Rosman and Pearce [Brain 1967; 90:829-838] have shown that neuronal heterotopias in deep cerebral white matter are associated with mental retardation in neurofibromatosis type 1 (NF-1), we hypothesized that these areas of increased signal seen on MRI should be associated with learning difficulties or incoordination in children with NF-1. Using MRI, we studied 31 children with NF-1 and attempted to correlate the presence of areas of increased signal with learning difficulties or incoordination. We found no association. This suggests that either these areas of increased signal are heterotopias which are not associated with learning difficulties or incoordination, or these areas of increased signal are not heterotopias and are not relevant to the study of learning problems or incoordination in children with NF-1.

Adolescent↗
PubMed1989

Neurofibromatosis, Charcot-Marie-Tooth disease, or both?

The simultaneous occurrence of neurofibromatosis and a peripheral neuropathy that has the clinical and electrophysiological features of Charcot-Marie-Tooth disease (HMSN I) has rarely been reported. A recent report described patients with HMSN I with hypertrophic lumbosacral nerve roots. We report a patient with compelling evidence for neurofibromatosis who also demonstrates clinical and electrophysiological features of Charcot-Marie-Tooth disease. Abdominal and pelvic CT scan revealed diffusely and symmetrically enlarged lumbosacral nerve roots. These nerve roots were biopsied, and the specimens revealed neurofibromas. Histology, electrophysiological studies, radiology, and clinical appearance of the abnormality in peripheral nerves and lumbosacral nerve roots will be emphasized in this paper. The simultaneous occurrence in our patient of neurofibromatosis and Charcot-Marie-Tooth disease suggests a possible genetic relationship between these two disorders.

Adult↗
PubMed1988

Status epilepticus in children: etiology, clinical features, and outcome.

Between August 1984 and September 1986, data were gathered prospectively on 114 episodes of convulsive status epilepticus, defined as seizure duration longer than 30 minutes, affecting 97 children. Status epilepticus was symptomatic in 72% (chronic 59%, acute 13%) and idiopathic or febrile in 28%. We identified precipitating factors in 63% of episodes. The most common factors were inadequate blood levels of anticonvulsants (32 of 60 episodes in children with prior seizures) and febrile illnesses, excluding meningitis or encephalitis (38 of 114 episodes). There was an elevated peripheral white blood cell count in 60%, acidosis with a pH of less than 7.0 in 12.5%, and cerebrospinal fluid pleocytosis not due to meningitis or encephalitis in 8 of 64 episodes. Eight children died, three with severe pre-existing brain damage, two with meningitis, and two with a poorly defined encephalopathy. Eighteen children developed a new neurologic deficit. Outcome was associated with the etiology and duration of status epilepticus, with age at the time of status a minor factor. A permanent deficit occurred in only five children with idiopathic or febrile status epilepticus.

Adolescent↗
PubMed1988

Cranial MR imaging in neurofibromatosis.

Cranial MR images of 53 patients with neurofibromatosis were reviewed to determine the nature, extent, and number of intracranial abnormalities present. All patients studied met tentative definitions established for the diagnosis of neurofibromatosis. Twenty-three were scanned for evaluation of known CNS of cranial nerve involvement; the remainder were neurologically asymptomatic patients without suspected lesions referred for screening. Single lesions were noted in 32 patients. Multiple lesions were identified in 14 patients. Seven had normal scans. In 23 patients small focal areas of increased signal on T2-weighted scans within the brain were though to represent heterotopias. Eight patients had chiasmal gliomas and two had optic nerve gliomas. Nine patients had parenchymal gliomas, two had ischemic changes, and one had a colloid cyst. Extraaxial lesions included acoustic neuromas (five patients), meningiomas (four), trigeminal neurofibromas (one), and dysplasia of a sphenoid wing (two). Of the 30 asymptomatic patients referred for screening, lesions were found in 23. MR was found to be an excellent method of imaging known disease and of detecting lesions in asymptomatic patients. Because of the large number of asymptomatic lesions detected in this population, a screening MR study is recommended in patients with neurofibromatosis.

Adolescent↗
PubMed1988

Normal SPECT thallium-201 bull's-eye display: gender differences.

The bull's-eye technique synthesizes three-dimensional information from single photon emission computed tomographic 201TI images into two dimensions so that a patient's data can be compared quantitatively against a normal file. To characterize the normal database and to clarify differences between males and females, clinical data and exercise electrocardiography were used to identify 50 males and 50 females with less than 5% probability of coronary artery disease. Results show inhomogeneity of the 201TI distributions at stress and delay: septal to lateral wall count ratios are less than 1.0 in both females and males; anterior to inferior wall count ratios are greater than 1.0 in males but are approximately equal to 1.0 in females. Washout rate is faster in females than males at the same peak exercise heart rate and systolic blood pressure, despite lower exercise time. These important differences suggest that quantitative analysis of single photon emission computed tomographic 201TI images requires gender-matched normal files.

Adult↗