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Biomedical subjects

M Manford

Publications and source records attributed to M Manford.

15 recordsLinked to original sources
PubMed1998

Complex visual hallucinations. Clinical and neurobiological insights.

Complex visual hallucinations may affect some normal individuals on going to sleep and are also seen in pathological states, often in association with a sleep disturbance. The content of these hallucinations is striking and relatively stereotyped, often involving animals and human figures in bright colours and dramatic settings. Conditions causing these hallucinations include narcolepsy-cataplexy syndrome, peduncular hallucinosis, treated idiopathic Parkinson's disease, Lewy body dementia without treatment, migraine coma, Charles Bonnet syndrome (visual hallucinations of the blind), schizophrenia, hallucinogen-induced states and epilepsy. We describe cases of hallucinosis due to several of these causes and expand on previous hypotheses to suggest three mechanisms underlying complex visual hallucinations. (i) Epileptic hallucinations are probably due to a direct irritative process acting on cortical centres integrating complex visual information. (ii) Visual pathway lesions cause defective visual input and may result in hallucinations from defective visual processing or an abnormal cortical release phenomenon. (iii) Brainstem lesions appear to affect ascending cholinergic and serotonergic pathways, and may also be implicated in Parkinson's disease. These brainstem abnormalities are often associated with disturbances of sleep. We discuss how these lesions, outside the primary visual system, may cause defective modulation of thalamocortical relationships leading to a release phenomenon. We suggest that perturbation of a distributed matrix may explain the production of similar, complex mental phenomena by relatively blunt insults at disparate sites.

Brain Diseases↗
PubMed1998

Case study: neurological brain waves causing serious behavioral brainstorms.

A case highlighting the association of epilepsy with psychopathology is reported. The patient suffered a rare and extreme behavioral disturbance, characterized by persistent disruptive behavior and intermittent bizarre and violent outbursts. These outbursts often appeared purposeful, but some of them were later diagnosed as ictal manifestations of temporal lobe epilepsy. Temporal lobectomy resulted in remission both of the epilepsy and of the more persistent behavioral disturbance. lctal behavioral change was masked by interictal behavioral disturbance, leading to delayed diagnosis and prolonged psychosocial dysfunction. It is important to record the paroxysmal abnormal behavior with simultaneous electroencephalographic recording if there is a suspicion of organic disease. Physical and psychosocial factors in the relationship between epilepsy and extreme psychiatric disturbance are considered. This case demonstrates how successful epilepsy treatment may produce amelioration of associated psychiatric disturbance.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed1996

An analysis of clinical seizure patterns and their localizing value in frontal and temporal lobe epilepsies.

The differentiation of frontal lobe epilepsy (FLE) and temporal lobe epilepsy (TLE) is a clinical problem of major theoretical and practical importance. Current electroclinical classification is based on retrospective studies of highly selected patients. When applied to the presurgical evaluation of patients, it has poor specificity. The current study adopts a different and prospective approach to the analysis of ictal clinical manifestations and their value in differentiating FLE and TLE. Two hundred and fifty-two patients with partial epilepsy were selected according to criteria of focal abnormality and imaging, ictal EEG or interictal EEG or highly focal clinical pattern. A witnessed seizure description was obtained for each of their habitual seizures and the sequence of manifestations encoded and entered into a statistical cluster analysis to form a clinical classification of the 352 seizures identified, which comprised 14 clinical groups. Neuroimaging abnormalities were measured, using a template technique, and graded 0-3 according to extent of involvement of each region in the lesion, using standard anatomical divisions. A chi 2 analysis of lesion location against seizure type was performed to assess the strength of association of seizure types with specific cerebral regions. The distribution of interictal EEG spikes and ictal EEG onsets were assessed qualitatively. An independent analysis was also performed, comparing clinical seizure manifestations associated with lesions restricted to either frontal or temporal lobes. Of the 14 clinical groups, four were predominantly related to temporal lobe abnormalities: fear/olfactory/gustatory; absence with no focal symptoms; experiential and visual. Within these groups, 45 out of 58 lesional cases involved the temporal lobes (P<<0.001). A minority of seizures in these groups were associated with frontal lesions and these seizures were significantly more likely to involve version/posturing, without an intervening absence phase, than the temporal cases (P<0.001). Two groups were related to perirolandic abnormalities; somatosensory and Jacksonian clonic with 22 out of 24 lesional cases involving this region (P<0.001). Two other groups were related to the frontal lobes; version/posturing and motor agitation. Early focal tonic activity or head turning were associated with lateral premotor lesions (P<0.001) and ictal and interictal EEG showed strong frontal predominance. Seizures characterized by general motor agitation were associated with lesions of the orbitofrontal (eight out of thirteen cases) and frontopolar (six out of thirteen cases) cortices (P<0.001). Location of interictal EEG spikes and ictal EEG onsets were generally consistent with lesion sites and where there were discrepancies, EEG localization tended to be more diffuse than lesion localization, rather than frankly discordant. Analysis of manifestations associated with pure frontal and pure temporal lesions supported the results of the cluster analysis and also showed a significant association of oro-alimentary automatisms with temporal lobe abnormalities. There were no consistent differences between groups with different localizations in terms of seizure frequency or other characteristics of seizure timing, although very high seizure frequencies were seen more often in association with frontal lesions. Only one combination of different seizure types in the same patient occurred with statistical significance: absence and generalized motor seizures and pseudo generalized epilepsy. The results of this study suggest that relatively few seizures can be localized reliably on clinical grounds and that even in those seizure types where there is a statistically significant association with specific cortical areas, an important minority do not share the same associations. Analysis of the seizure evolution as well as initial symptoms may be of value in localizing some cases, but even here wide variation occurs...

Cluster Analysis↗
PubMed1992

The National General Practice Study of Epilepsy. The syndromic classification of the International League Against Epilepsy applied to epilepsy in a general population.

In this prospective, population-based study of 594 cases of newly diagnosed epilepsy, proportions in categories as defined by the International League Against Epilepsy (ILAE) were as follows: (1) localization-related epilepsies: 1.1* idiopathic, 1.2%; 1.2* symptomatic, 16.2%; and 1.3 cryptogenic, 24.6%; (2) generalized epilepsies: 2.1* idiopathic (idiopathic generalized epilepsy) with 3-Hz spike and wave: absence epilepsy, 2.2%; juvenile myoclonic epilepsy, 1.5%; and nonspecific idiopathic generalized epilepsy, 5.6%; 2.3.1* symptomatic generalized epilepsies, 1.5%; 2.3.2* specific syndromes with generalized epilepsy, 0.3%; 3.2 seizures without unequivocal focal or generalized features, 32%; 4.1 situation-related syndromes, isolated seizures, 9.9%; seizures due to acute toxic or metabolic cause,* 4.5%. Only 33.6% were in diagnostic ILAE categories (asterisks) and many rare syndromes were not represented. The remainder (66.4%) were in various nonspecific categories. Only 24% of localization-related epilepsies could be clinically localized to a single ILAE-proposed site of origin and of these best localized cases, 14% had strongly discordant imaging or electroencephalograms. These major problems in applying the ILAE classification to epilepsy in the general population and its underemphasis of modern imaging techniques are discussed.

Cerebral Cortex↗
PubMed1992

Prolonged sensory or visceral symptoms: an under-diagnosed form of non-convulsive focal (simple partial) status epilepticus.

Four patients had prolonged, sensory, simple partial seizures (SPS), lasting up to several days, without associated behavioural impairment. In three patients, the SPS often occurred as a prolonged "aura" before a more overt seizure. Descriptions included: "butterflies", rising epigastric sensation; "a thought in the stomach", and an olfactory sensation. Seizure localisation was frontal in one case, temporal in two cases and uncertain in one case. These sensations may represent an under-reported form of continuous, focal seizure activity, which arises from various cerebral regions.

Adult↗
PubMed1992

Infective endocarditis in a district general hospital.

Thirty-three cases of infective endocarditis presenting during a 6.5 year period to a district general hospital were analysed retrospectively. The annual incidence was 22 cases per million population. Twenty-two cases had pre-existing cardiac disease, mainly valvular disease-usually rheumatic (nine cases) and prosthetic valves (10 cases). Recognizable precipitants such as recent surgery were uncommon. Two cases presented after deliberate drug overdose possibly due to depression exacerbated by systemic disease. Symptoms were usually non-specific. All but two cases had murmurs and most were pyrexial. Splinter haemorrhages and clubbing were seen in about 20% of cases. Viridans-type streptococci were the commonest infecting organisms (14 cases). Staphylococcal infection (six cases) was confined to intravenous drug abusers and patients with prosthetic valves. Five cases were culture negative. Cardiac failure was present in 13 cases at presentation and developed in seven others during treatment. Acute valve replacement was necessary in eight cases, and late replacement in three. Renal impairment (plasma urea > 8 mmol/l and/or plasma creatinine > 120 mumol/l) occurred in 19 cases during the course of their illness. Embolic phenomena occurred in 12 patients and mostly involved the central nervous system. In the 8 fatal cases, the cause of death was cardiac failure in six, cerebrovascular accident in one, and myocardial infarction in one. Four of the six patients who subsequently died of cardiac failure had been referred for surgery. Both those who were not referred had coexisting medical problems. Factors associated with increased mortality were age, male sex, cardiac failure (P < 0.01), renal impairment (P < 0.05), and embolic phenomena (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

National General Practice Study of Epilepsy (NGPSE): partial seizure patterns in a general population.

The National General Practice Study of Epilepsy (NGPSE) is a prospective community-based study of newly diagnosed epileptic seizures. Of 594 patients with definite epileptic seizures, 160 (26.9%) had seizures with a clinically localizable onset: 36 (22.5%) frontal, 52 (32.5%) central sensorimotor, 43 (27%) temporal, nine (5.6%) frontotemporal, and 10 each (6.3%) parietal and other posterior cortex. There was no difference among these groups in seizure frequency or remission rate; 46.5% were seizure free and 6.9% had severe epilepsy. Etiology was identifiable in 41% and focal CT and EEG abnormalities in 33% and 19%, with results discordant with the clinical seizure localization in 21% and 20%. Temporal lobe epilepsy may be underreported, as it may be more difficult to localize clinically. Extratemporal seizures are extremely common in the general population, especially frontal and central sensorimotor, in relation to cerebrovascular disease. Prognoses are similar for partial epilepsies with different clinical patterns and regions of onset and are much better than suggested in hospital-based studies. The clinical, EEG, and CT localizations may frequently be discordant in this nonrefractory group.

Electroencephalography↗
PubMed1984

Postnatal development of ipsilateral retino-geniculate projections in normal albino rats and the effects of removal of one eye at birth.

The postnatal development of ipsilateral retinofugal projections to the lateral geniculate body in normal albino rats, and in rats unilaterally enucleated at birth has been examined. At postnatal ages ranging from 1 day to 6 months, horseradish peroxidase was injected into one eye of normal rats and into the remaining eye of neonatally enucleated animals. After approximately 20 hours, the animals were perfused, the brains sectioned and reaction product visualised using tetramethylbenzidine. Ipsilateral retinal projections to the lateral geniculate body in normal animals were extensive on postnatal day 1 and became reduced over the next few days, the adult pattern being established between days 9 and 12. In the enucleated group, the terminal fields of the ipsilateral projections to the lateral geniculate body from the remaining eye remained larger and displayed a greater density of terminal labelling than in age-matched controls. In addition, the ipsilateral terminal field in the dorsal lateral geniculate nucleus occupied a more lateral position than in control animals. These findings support previous suggestions that the abnormally large ipsilateral retino-fugal projections observed in adult rats following removal of one eye, at or close to, birth, result from a failure of the ipsilateral projection to become restricted and that terminal or preterminal sprouting of retinal axons may also make a small contribution to the formation of the exuberant ipsilateral projection.

Animals↗