Four siblings with malformations due to maternal epilepsy and anticonvulsants.
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Abnormalities, Multiple↗
Biomedical subjects
L Ch'ien
Publications and source records attributed to L Ch'ien.
Comparison of neuropsychologic functioning and clinical indicators of neurotoxicity in long-term survivors of childhood leukemia given cranial radiation or parenteral methotrexate: a prospective study.
We prospectively compared neuropsychologic functioning and clinical indicators of neurotoxicity in 49 consecutive childhood leukemia patients in long-term continuous complete remission (CR) who had received two different regimens of CNS prophylaxis by random assignment. Twenty-three patients were treated with 1,800 cGy cranial radiation and intrathecal methotrexate (RT group) and 26 with parenteral methotrexate only (MTX group). Over half of the RT group had somnolence syndrome, and four developed cerebral calcifications late in their clinical course. Abnormal electroencephalograms (EEGs) were seen in 15 patients in the MTX group, and six had early, transient white-matter hypodensities apparent on computed tomographic (CT) scans. Mean scores on standard tests of intelligence and academic achievement, administered after remission induction and again at a median of 6 years after treatment cessation, did not differ significantly between the two groups. However, statistically significant decreases in overall and verbal intelligence quotients (IQs) and in arithmetic achievement were found within both treatment groups. Sixteen of 26 in the MTX group and 14 of the 23 in the RT group had clinically important decreases (greater than or equal to 15 points) on one or more neuropsychologic measures. These changes did not correlate with findings on CT scans, EEGs, or other clinical signs of neurotoxicity. We conclude that 1,800 cGy cranial radiation and parenteral methotrexate, as used in this study, are associated with comparable decreases in neuropsychologic function.
Adolescent↗
Serial cranial computed-tomography scans in children with leukemia given two different forms of central nervous system therapy.
Cranial computed tomography (CT) was used to estimate the frequency and permanence of brain abnormalities in 108 consecutive children with acute lymphoblastic leukemia (ALL). Fifty-five patients received cranial irradiation (1,800 rad) with intrathecal methotrexate (RT group) and 53 patients received intravenous and intrathecal methotrexate without irradiation (IVIT group). Continuation treatment included sequential drug pairs for the RT group and periodic IVIT methotrexate for the other group. After 12 to 24 months of serial evaluation, five (9%) of the 55 patients in the RT group have had CT scan abnormalities, compared to 10 (19%) of 52 in the IVIT group (p = 0.171). Fourteen of the 15 patients with CT scan abnormalities had focal or diffuse white-matter hypodensity; these have reverted to normal in most cases, reflecting a dynamic process. While such CT findings are of concern and may be an early indicator of central nervous system toxicity, this remains to be proven. Therapy should not be altered on the basis of abnormal CT scans alone but in the context of the entire clinical situation.
Adolescent↗
Perinatal study in Tientsin: 1978.
Clinical records of a total of 3320 singleton births, representing the year 1978, at the two Tientsin Medical College Hospitals, Tientsin, People's Republic of China, were studied to ascertain (a) reproductive parameters such as the average age of the mothers at first and successive births and (b) the relationships between perinatal deaths, prematurity and birth weight and the mothers's age, number of previous pregnancies, parity, maternal conditions in the prenatal and delivery period and operative procedures of delivery.
Adult↗
Disturbances of rapid-eye-movement sleep in 3 brothers with Pelizaeus-Merzbacher disease.
The electrophysiological features of 3 brothers with the classic form of Pelizaeus-Merzbacher disease (PMD) were studied. Two consecutive overnight polygraphic sleep recordings indicated a gross distortion of rapid-eye-movement (REM) sleep for all patients. A lower than normal percentage of REM sleep in these patients was consistent with their retarded intellectual development, which supports current thinking that REM sleep may be a sensitive index of brain function integrity. Non-rapid-eye-movement (NREM) sleep, in contrast to reported findings in 1 patient with PMD, was uniformly characterized by distinct stages in which the electroencephalograms contained frequent vertex waves and spindles. Tests of peripheral nerve conduction velocity, acoustic brainstem reflexes, and visual and auditory evoked potentials did not indicate any abnormalities, nor did electroencephalograms obtained during wakefulness. One patient did have epileptiform spikes and spike waves recorded during an all-night EEG, an unusual finding in a child with cerebral white matter disease.
Adolescent↗
Visual evoked potentials in Reye's syndrome.
Visual evoked potentials (VEPs) induced by flash stimulation in a child who was recovering from Reye's syndrome with complaints of poor left-eye vision were recorded. Ophthalmological examination disclosed intact visual fields and normal visual acuity. Analysis of VEP's, however, showed a grossly abnormal configuration of wave forms, marked prolongation in latency and reduction in amplitude when the left eye was stimulated. Follow-up observation 3 weeks later showed parallel improvements in VEPs and subjective complaints. Thus, from VEP analysis, it may be possible to detect subtle changes in the visual system that have diagnostic and prognostic value.
Adolescent↗
Virus in brain of child with hemiplegia, hemiconvulsions, and epilepsy.
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Brain↗
Seronegative dementia paralytica: report of a case.
Dementia paralytica may present diagnostic difficulties when routine serological test using a non-treponemal antigen is non-reactive. We present an illustrative demented patient who initially had negative VDRL test both in his serum and cerebrospinal fluid. However, the brain biopsy specimen showed active meningoencephalitis. By special staining technique, a spiral organism was found in the brain exhibiting morphology perfectly compatible with treponema pallidum. Later in the course, the VDRL became reactive in the blood but remained non-reactive in the cerebrospinal fluid. On the basis of the experience of other workers in the field and ours with this patient, we advise the use of FTA-ABS test as a screening procedure in patients with neurological problems of possible syphilitic origin. We urge further research in this field.
Adult↗