PubMed Health⌕ Search

Biomedical subjects

J W Lance

Publications and source records attributed to J W Lance.

At least 127 records · Page 7Linked to original sources
PubMed1977

The anticonvulsant action of sodium valproate (Epilim) in 100 patients with various forms of epilepsy.

Sodium valproate (Epilim) has been used in the management of 100 patients with previously uncontrolled epilepsy for periods up to 2 years. If all manifestations of epilepsy are considered together, 75% to 100% control of seizures was achieved in 43% of patients, 25% to 74% control in 26%, and no improvement occurred in 31% of patients. Control of 75% to 100% was achieved in 57% of patients with a spike and wave electroencephalogram (EEG) disturbance but only in 35% of those with focal abnormalities, excessive slow activity, or normal records. When the various manifestations of epilepsy were considered individually, the greatest improvement was found among the patients with the minor forms of generalized epilepsy (petit mal absences, myoclonus and atonic attacks) in whom 75% to 100% control was obtained in 67%, compared with 43% of those with major generalized seizures (grand mal) and 30% of those with temporal lobe attacks and other forms of focal epilepsy. Gastrointestinal disturbances and drowsiness were noted as side effects in the early stages of treatment, but the majority of patients tolerated the drug well and many commented on increased mental alertness while taking it. Two patients were over-stimulated and some noticed tremor or twitching as side effects. Some minor abnormalities in blood coagulation studies were noted, but these were transient and did not appear to be of clinical significance. Regular blood counts and biochemical studies have not shown any significant changes. Sodium valproate appears to be a safe and useful anticonvulsant with the advantage that it usually makes patients brighter rather than drowsier. Abnormalities of platelet function have been described in some overseas reports, so that any unexplained bruising or bleeding in a patient taking valproate is an indication for a platelet count and coagulation studies.

Adolescent↗
PubMed1977

Sodium valproate and clonazepam in the treatment of intractable epilepsy.

Of 88 patients with intractable epilepsy, 60 have been treated with clonazepam for up to three years and 60 have been treated with sodium valproate for up to 18 months. Each agent was used sequentially in an overlapping group of 32 patients. Both agents have proven effective in the control of petit mal absences and myoclonic jerks, although some patients responded to one and not to the other. Clonazepam has given better results than valproate in temporal lobe and other partial (focal) epilepsies, while valproate has given better results in grand mal seizures and atonic attacks. Both preparations were more effective in patients with spike and wave paroxysms in their EEG recordings, the correlation being more conspicuous with valproate. Both medications appear to be safe and useful additions to anticonvulsant therapy.

Adolescent↗
PubMed1977

Familial paroxysmal dystonic choreoathetosis and its differentiation from related syndromes.

Four generations of a family are described in which 7 of 8 affected members suffered from prolonged dystonic seizures; the eighth member's attacks were those of paroxysmal choreoathetosis. The attacks lasted up to 4 hours, were precipitated by alcohol, emotion, or fatigue, and responded poorly to phenytoin and barbiturates but were controlled by clonazepam. Autopsy on an affected child who died a "crib death" at the age of 2 years disclosed no major abnormality of the brain. This family appears to have the same condition as that described by Mount and Reback in 1940, Forssman in 1961, and Richards and Barnett in 1968, which the last authors termed paroxysmal dystonic choreoathetosis to distinguish it from the more common movement-induced (kinesigenic) form of the disorder. Analysis of reports of 100 cases of paroxysmal kinesigenic choreoathetosis shows that the attacks last less than 5 minutes, are precipitated by sudden movement or startle, and usually respond well to phenytoin or barbiturates. A clinical classification is presented in which the kinesigenic form is divided into a familial group (72% of cases) and a sporadic group (28% of cases) and contrasted with paroxysmal dystonic choreoathetosis. One family with an intermediate form, in which dystonic choreoathetosis was provoked by continued exertion and lasted for up to 30 minutes, is also reported.

Adult↗
PubMed1977

Migraine stupor.

Explore the source record for details and available documents.

Adolescent↗
PubMed1977

Plasma sodium valproate levels and clinical response in epilepsy.

Serial plasma levels of sodium valproate were estimated in 12 epileptic patients and 10 normal subjects after a single dose of the drug, whilst random estimations were performed in another group of 32 patients already stabilised on sodium valproate. The tentative conclusions arrived at by this study were: 1) In the majority of patients and normal subjects peak plasma levels were reached by the end of the first or second hour. 2) The majority of clinically controlled subjects showed a plasma level above 40microgram/ml. 3) Similar doses of sodium valproate (mg/kg) produced higher plasma levels in normal subjects than in the epileptic patients. Whether this is an effect of other anticonvulsants the patients were taking at the same time is a matter for conjecture. 4) Dosage and plasma levels did not appear to show a close correlation. 5) Random estimation of plasma levels are of little value for monitoring therapeutic efficacy, unless timed in relation to the dose, for reasons already mentioned above.

Anticonvulsants↗
PubMed1977

Motor neuron disease in Australia (State of New South Wales).

The case histories of 70 patients with typical motor neuron disease (MND) have been analysed to ascertain the natural history of the disease in Australia. The place of birth and residence during life of each patient has been sought to determine whether there is any 'clustering' of patients in the State of New South Wales. The mean age of onset was 55 years and mean duration of life from onset was 3 years 5 months. These figures are comparable with those from the USA and UK and Japan although the onset in Australia was later and the duration longer. The case history of 1 patient who is still living 38 years after the onset of the disease is described as there is no longer survival time recorded in the literature to our knowledge. Attention is drawn to muscle aches and cramps mentioned spontaneously by 27 of the 70 patients. These symptoms occurred at the onset of MND and often correlated with the site of onset of weakness. Weight loss averaged 1.6lb (0.7kg) per month in those patients in whom weight was recorded. The CSF protein was greater than 45mg/100ml, ranging up to 110mg/100ml, in 9 of 37 patients. The place of residence of patients bore no relation to known areas of increased manganese in the soil, and there was no evidence of 'clustering' of cases.

Adolescent↗
PubMed1976

Bacloffen (Lioresal) in the long-term management of spasticity.

This report summarizes experience with baclofen (Lioresal) in the management of spasticity and muscle spasms in 113 patients treated for up to six years. Baclofen was found to be of little help in nine patients with spasticity of cerebral origin, but was effective in reducing spasticity of spinal origin in 72 out of 90 patients (80%). It also reduced the number and severity of spasms in 76 out of 87 patients (87%). Side effects necessitating reduction of dosage were experienced by 20% of patients. Baclofen appears to be a safe and effective agent in the management of spasticity, with the advantage that adequate dosage can usually be achieved without sedation. Beneficial effects have persisted throughout the follow-up period.

Adolescent↗
PubMed1976

Symptoms of pheochromocytoma, with particular reference to headache, correlated with catecholamine production.

In a series of 27 patients with proved pheochromocytoma, differential analysis of catecholamines in blood, urine, and tumor specimens of 19 patients enabled grouping of subjects into those whose tumors produced predominantly norepinephrine (NE) (11 patients), predominantly epinephrine (E [Two patients]) and approximately equal amounts of both (six patients). Sustained hypertension was more common in the first group and pallor and tremor in the latter two groups, but no distinctive syndrome could be recognized as signifying the secretion of NE or E. Headache was a symptom in 20 of 27 patients and was related to sudden, transient elevation of the blood pressure, rather than sustained hypertension. The variable duration and intensity of the headache in different patients can be explained by the pressor and cranial vasoconstrictor effects of the secreted amines, which respectively enhance and diminish vascular headache.

Adolescent↗
PubMed1976

Simple formed hallucinations confined to the area of a specific visual field defect.

Thirteen patients with transient or permanent homonymous visual field defects experienced formed hallucinations localized to the affected part of the visual field. The lesion was occipital in 8 instances (infarction 7, porencephalic cyst 1), parietooccipital in 3 (infarction 2, angioma 1) and probably parietal in 2 (epilepsy 1, encephalitis 1). The disorder involved the right hemisphere in 9 cases, the left hemisphere in 3 cases and both hemispheres sequentially in one patient. Hallucinations were accompanied by palinopsia in 2 cases, metamorphopsia in one case and constriction of one pupil in another case. This particular type of hallucination is considered as an irritative phenomenon of the visual association cortex which can be symptomatic of a parieto-occipital lesion and does not necessarily implicate the temporal lobes. Distinctive features about the visions were that they consisted of people, animals or objects. There was no auditory accompaniment and any action that took place was stereotyped and did not tell a story. In most cases, the hallucinations were not clearly related to any visual memory. It is suggested that the visual association cortex amy be responsible for the organization of visual percepts into broad categories of which people, animals and objects are representative. The occurrence of such hallucinations with a visual field defect suggests that the cells of the association cortex are more likely to discharge spontaneously once they are deprived of their normal afferent inflow from the calcarine cortex.

Adolescent↗
PubMed1976

Headaches related to sexual activity.

Twenty-one patients experienced headache related to sexual activity. Two varieties of headache could be distinguished from the clinical histories. The first, developing as sexual excitement mount, had the characteristics of muscle contraction headache. The second, severe, throbbing or 'explosive' in character, occurring at the time of orgasm, was presumably of vascular origin associated with a hyperdynamic circulatory state. Two of the patients with the latter type of headache had each experienced episodes of cerebral vascular insufficiency on one occasion which subsequently resolved. A third patient in this category had a past history of drop attacks. No evidence of any structural lesion was obtained on clinical examination or investigation, including cerebral angiography in seven patients. Eighteen patients have been followed up for periods of two to seven years without any serious intracranial disorder becoming apparent. While the possibility of intracranial vascular or other lesions must always be borne in mind, there appears to be a syndrome of headache associated with sexual excitement where no organic change can be demonstrated, analogous to benign cough headache and benign exertional headache.

Adolescent↗