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Biomedical subjects

M R Trimble

Publications and source records attributed to M R Trimble.

At least 19 recordsLinked to original sources
PubMed1992

Elevated frontal cerebral blood flow in Gilles de la Tourette syndrome: a 99Tcm-HMPAO SPECT study.

Case reports, numerous brain imaging studies, and certain disease states suggest that the orbital frontal cortex and the striatum are dysfunctional in obsessive-compulsive disorder (OCD). Interest has also grown recently concerning the genetic, neuroanatomic, and clinical links between OCD, chronic motor tics, and Gilles de la Tourette Syndrome (GTS). To test the hypothesis of possible orbito-frontal/basal ganglia dysfunction in GTS, similar to OCD, we studied 20 unmedicated GTS subjects, 10 of whom also had comorbid OCD (GTS/OCD), and 8 control subjects. The subjects were examined with high-resolution single photon emission computed tomography (SPECT) and the labeled regional cerebral blood flow (rCBF) ligand technetium-99m-d,l-hexamethyl-propylene amine oxime (99Tcm-HMPAO). As a group, GTS subjects showed significantly elevated right frontal/visual cortex activity (mean = 0.879, SD = 0.107) compared with control subjects (mean = 0.798, SD = 0.049). A subanalysis comparing simple GTS versus GTS with comorbid OCD failed to reveal significant differences in regional flow.

Adult↗
PubMed1992

Effect of vigabatrin on striatal dopamine receptors: evidence in humans for interactions of GABA and dopamine systems.

Vigabatrin is a specific gamma-aminobutyric acid transaminase inhibitor. The clinical use of this drug in the treatment of epilepsy has been sporadically linked to the development of psychosis. Using 123I-IBZM, a specific dopamine D2 receptor ligand and single photon emission tomography (SPET), one month of treatment with vigabatrin was associated with a decrease in specific binding of 123I-IBZM to D2 receptors in the left hemisphere basal ganglia. This change may provide one explanation for the development of psychosis in vulnerable patients.

Adolescent↗
PubMed1992

The changing 19th-century view of epilepsy as reflected in the West Riding Lunatic Asylum Medical Reports, 1871-1876, vols 1-6.

The West Riding Lunatic Asylum Medical Reports (WRLAMR) were published from 1871 to 1876. Organized by Sir James Crichton-Browne at a little-known mental asylum in northern England, the WRLAMR contains many historically important works in neurology by such landmark figures as Sir David Ferrier and John Hughlings Jackson. The writings on epilepsy in the WRLAMR are particularly important and reveal the 19th-century shift in understanding the etiology of seizures.

England↗
PubMed1991

Electroconvulsive therapy in Parkinson's disease and other movement disorders.

Early case reports note marked improvements in the signs of Parkinson's disease (PD) in several patients with coexisting psychiatric disorders after treatment with electroconvulsive therapy (ECT). Studies since 1959 reveal improvement of parkinsonism in over half of PD patients receiving ECT, regardless of the presence or absence of psychiatric comorbidity. Drug-induced parkinsonism, tardive dystonia, and tardive dyskinesia have also been shown to improve with ECT administration; tic syndromes have achieved mixed results. In animals, ECT enhances dopamine-mediated effects and increases GABA concentrations in the CNS. Optimal parameters relevant to the antiparkinsonism effects of ECT require further study.

Depressive Disorder↗
PubMed1991

Vigabatrin and psychosis.

We report a series of 14 cases of psychosis occurring in patients with severe intractable epilepsy, following the prescription of vigabatrin, a new antiepileptic drug. Nine patients had no previous history of psychosis. In eight patients the psychosis occurred following a change in the habitual pattern of seizure activity; in four it developed after a period of seizure freedom followed by a cluster of seizures, and in the other four patients an alternating psychosis was observed. In five patients there was no clear relationship to seizure pattern. Another patient developed psychosis after taking an overdose of between eight and 12 g of vigabatrin. A further three patients, who developed psychosis following vigabatrin withdrawal, were not included in this series. The mean dose at onset of the psychosis (excluding the patient who took an overdose) was 2580 mg, and the period from initiation of therapy to the onset of psychosis varied from five days to 32 weeks (and occurred 24 hours after the overdose of vigabatrin). In all cases the psychosis resolved, but necessitated the withdrawal of vigabatrin, except in the single patient who took the overdose. The mechanism of this behaviour change is unclear, but in some instances may reflect vigabatrin's powerful anti-epileptic action. This is clearly not the case for all patients. Vigabatrin should be started with caution in patients with severe epilepsy, particularly in the presence of a previous history of psychosis, and such patients should be carefully monitored.

4-Aminobutyrate Transaminase↗
PubMed1991

Psychosis following temporal lobe surgery: a report of six cases.

Six consecutive patients who had had temporal lobe surgery for epilepsy, and been referred for psychiatric assessment of psychotic symptoms, are reported. Their symptoms (a delusional depression, four schizophrenia-like illnesses, and a case of Capgras' syndrome) are discussed in relation to the possible role of their operations, all of which were on the right hemisphere.

Adult↗
PubMed1991

'Hysteria', 'functional' or 'psychogenic'? A survey of British neurologists' preferences.

The diagnostic preferences of British neurologists for patients who lack a physical explanation for their symptoms were assessed by means of a postal questionnaire. Analysis of 168 completed replies showed 'functional', 'psychogenic' and 'hysteria' to be the most popular terms in use. The number of different terms a clinician would use rose in line with the volume of such patients they encountered, but was unrelated to clinician factors such as the extent of their clinical experience in psychiatry. A specific enquiry into these respondents' interpretation of the term 'functional' revealed a clear consensus as to which syndromes it should apply to, although this consensus was not shared by a comparison group of psychiatrists.

Conversion Disorder↗
PubMed1991

Gilles de la Tourette syndrome in the Middle East. Report of a cohort and a multiply affected large pedigree.

In a cohort of five patients from the Middle East with the Gilles de la Tourette syndrome, family history of a tic disorder or the Gilles de la Tourette syndrome was positive in three cases. In one of these there was a multiply affected pedigree spanning six generations. The phenomenology of the syndrome is the same as that described in Western reports. The familial pattern of inheritance and cross-cultural similarity emphasise the biological factors in the aetiology of the syndrome.

Adult↗
PubMed1991

Is money a cure? Follow-up of litigants in England.

American and British authors collaborated on a follow-up study in England of accident victims who brought litigation which had been resolved. Eighteen subjects who had complained of psychiatric symptoms during the course of the litigation were recruited from the British psychiatrist's files. Based on review of court documents and extensive interviews of the subjects, the authors describe case examples that demonstrate a complicated relationship between monetary compensation and outcome. Some of the litigants improved after they received compensation, but this seemed to be related to issues besides the money, e.g., feelings about their impairment, family support, the loss or gain of a relationship, personality characteristics, and ability to return to work. The authors discuss the results of this study in light of differences between the British and American legal systems.

Accidents↗
PubMed1990

Psychopathology of frontal lobe syndromes.

In this review, some basic aspects of frontal lobe functioning have been discussed and methods of testing for frontal lobe abnormalities outlined. It has been emphasized that the frontal lobes are affected in a number of diseases, which cover a broad spectrum of neuropsychiatric problems. Furthermore, it is suggested that the frontal lobes are involved in syndromes not traditionally thought to be related to frontal lobe dysfunction, for example, schizophrenia, and rarer presentations such as misidentification syndromes. Frontal lobe dysfunction often goes unrecognized, especially in patients who have normal neurologic testing and apparently intact IQ when routine methods of investigation are employed. Although marked disturbances of behavior following frontal lobe dysfunction have now been described for well over 120 years, these large areas of the human brain, and their links with some of the highest attributes of mankind, have been relatively neglected and are worthy of much further exploration by those interested in neuropsychiatric problems.

Brain Diseases↗
PubMed1990

Antiepileptic drugs, cognitive function, and behavior in children: evidence from recent studies.

The effects of antiepileptic drugs (AEDs) on cognitive function and behavior in children are reviewed on the basis of published studies. Individual AEDs have been shown to differ--the deleterious effects of phenytoin generally contrasting with the relatively minimal effects of valproate and carbamazepine. Some of the differences between results may be attributed to the psychological tests used and to age differences. However, there appears to be a dissociation between AEDs that affect higher cognitive function, e.g., phenytoin, and those mainly affecting motor function, e.g., carbamazepine, which appears to increase speed of performance, AEDs should be prescribed with care in children with epilepsy, taking account of their differing effects on cognitive function and behavior.

Adult↗