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Biomedical subjects

P A Kempster

Publications and source records attributed to P A Kempster.

At least 19 recordsLinked to original sources
PubMed2006

Sporadic encephalitis lethargica.

Three women (aged 21-36 years) developed acute illnesses that were similar to epidemic encephalitis lethargica. Each presented with a neuropsychiatric disturbance that was succeeded by pyrexia, a fluctuating conscious state and involuntary movements including oculogyria. Cerebrospinal fluid examination showed a predominantly lymphocytic pleocytosis (64-120x10(6) cells/L) and oligoclonal bands were detected in two cases. Two patients died, while the third made a gradual recovery. Post-mortem examination in the two fatal cases showed changes of lymphocytic meningitis and focal diencephalic lymphocytic infiltration, although these changes were mild relative to the effects of the clinical illness. The diagnosis of sporadic encephalitis lethargica relies on identifying shared clinical features with the past epidemic disease plus circumstantial evidence of immunological activity from laboratory investigations and some tests of exclusion of other disorders.

Adult↗
PubMed2006

Staying on the surface.

Every neurologist needs to develop an effective technique to diagnose and manage non-organic disorders, although there are different ways to go about it. The complex relationship that exists between functional and organic illness is an inescapable theme in daily neurological practice. Usually, it is better to read these case stories by examining their surface detail rather than to try to understand their psychological depth.

Case-Control Studies↗
PubMed2006

Looking for clues.

At certain moments in clinical practice, one can seem to possess the powers of a Sherlock Holmes to search out clues and deduce the diagnosis. Many neurologists are aware of links between the workings of detective fiction and the methods of problem-solving in neurological cases. One similarity concerns the professional counterpart of the conventional detective story, the single case report.

History, 19th Century↗
PubMed2006

Reading a story.

Case delineation in clinical medicine is the technique of creating a narrative that allows the appropriate scientific knowledge to be brought to bear. Neurologists get to be good at this type of story reading and telling from dealing with clinical stories which are relatively long and complicated. These skills are evident whenever working neurologists gather to discuss case material, or when studying their written clinical communications. The purpose of the article is to analyze this aspect of everyday neurological practice by looking at some of the general principles of story telling and appreciation.

Communication↗
PubMed1999

Evolution of motor fluctuations in Parkinson's disease: a longitudinal study over 6 years.

A prospective longitudinal 6-year study of 34 patients with Parkinson's disease from the time of initiation of drug treatment explored changes in the motor response to L-dopa over the early to mid disease course. Motor fluctuations developed in 41% after a mean L-dopa treatment interval of 25 months and dyskinesia developed in 53% after a mean of 15 months' treatment. Patients who developed fluctuations had a significantly better response to L-dopa than nonfluctuators. Nonfluctuators also had significantly greater "midline" motor disability affecting cranial and truncal muscles and gait. The development of motor fluctuations may simply reflect a retained capacity to respond to L-dopa as endogenous dopaminergic neurotransmission declines with progressive nigral cell loss. Many patients who show no sign of motor fluctuation 5 or 6 years into the disease course have a relatively blunted response to L-dopa. The proportion of such cases seems to correspond to the percentage that have coexisting striatal pathologic changes in postmortem studies.

Adult↗
PubMed1994

Motor response to levodopa in patients with parkinsonian motor fluctuations: a follow-up study over three years.

To clarify the way in which the clinical response to levodopa changes with the progression of Parkinson's disease, a longitudinal study was performed to quantify motor response characteristics to single doses of levodopa by mouth over three years in 23 patients with fluctuating motor function. A significant increase in motor disability in "on" (time of peak motor improvement) and "off" (before levodopa dose) phases occurred and "on" phase dyskinesia increased by 24%, though the amplitude of motor response was conserved. There was no evidence of progressive loss of response of certain motor deficits affecting axial muscles and gait. The mean duration of motor response decreased by 17%. Both shortening of response duration and increase in "off" phase disability contribute to the development of motor fluctuations. A short response time to the levodopa test dose was not an invariable finding in patients with severe fluctuations, whereas all had large response amplitudes and high "off" phase disability scores. Patients who have developed motor fluctuations may continue to respond to dopaminergic treatment until late in the disease course, despite the unstable nature of their responses.

Adult↗
PubMed1994

Response to L-dopa and evolution of motor fluctuations in the early phase of treatment of Parkinson's disease.

Twenty patients with Parkinson's disease were studied during the early phase of L-dopa treatment to clarify the development and progression of Parkinsonian motor fluctuations. Two patients had developed symptomatic motor fluctuations of moderate severity and another 3 had mild fluctuations. Both the initial response to L-dopa and the amplitude of response to a L-dopa test dose after a mean follow up period of 30 months were significantly greater for the fluctuating patients compared with those without fluctuation (p < 0.05). Although severe motor fluctuations do not usually develop until a number of years of L-dopa treatment have elapsed, this study shows that motor fluctuations can be detected quite early in the disease course and tend to appear in those patients who respond best to L-dopa.

Aged↗
PubMed1994

Dietary factors in the management of Parkinson's disease.

Oral administration of L-dopa is currently the most effective way to treat the cerebral dopamine deficiency which causes Parkinson's disease. Unfortunately, many patients with advanced Parkinson's disease develop an unstable pattern of response to L-dopa because of fluctuating delivery of the drug to the brain. Diet contributes to this problem through its adverse effects on L-dopa pharmacokinetics. This article reviews dietary strategies to improve responsiveness to pharmaceutical L-dopa treatment and the potential use of food as a source of L-dopa. Nutritional factors concerning weight loss and energy balance in Parkinson's disease are also discussed. A set of dietary guidelines is developed to assist clinical nutritionists and neurologists in the practical management of patients with Parkinson's disease.

Brain↗
PubMed1991

Intermittent subcutaneous apomorphine injection treatment for parkinsonian motor oscillations.

Eight patients with severe Parkinsonian motor oscillations have been treated with the dopamine receptor agonist apomorphine by intermittent subcutaneous self-injection as an adjunct to oral anti-Parkinsonian medication. The dopamine receptor antagonist domperidone was also given by mouth to prevent nausea. Six patients remain on chronic treatment (mean period 6.5 months) with improved control of motor function in each case. Four have had major enhancement of their quality of life. Benefits of this treatment stem from the training of patients to use intelligent behaviour to administer a promptly acting and effective pharmacological agent, thereby exercising a degree of direct control over previously unpredictable variations in motor performance.

Administration, Oral↗
PubMed1990

Comparison of motor response to apomorphine and levodopa in Parkinson's disease.

The magnitude and pattern of motor responses to single doses of subcutaneous apomorphine and oral levodopa were compared in 14 patients with Parkinson's disease. Although apomorphine produced much shorter motor responses than levodopa, the quality of response to the two drugs was virtually indistinguishable. These clinical observations support the notion that integrity of striatal post-synaptic dopamine receptors is a key determinant of responsiveness to dopaminergic treatment in Parkinson's disease.

Administration, Oral↗
PubMed1990

Diurnal differences in response to oral levodopa.

Diurnal differences in duration and quality of motor response to levodopa are frequently described by patients. The quality and duration of motor responses were objectively assessed to morning and afternoon oral levodopa doses in five patients with Parkinsonian motor fluctuations who complained of diurnal variation in response to their normal levodopa medication. Results suggest that under controlled conditions which eliminated the effects of diet and overlapping levodopa effects the response to levodopa remained unchanged throughout the day, and that the duration of response could be predicted by plasma levodopa levels.

Administration, Oral↗
PubMed1990

Subcutaneous apomorphine in the treatment of Parkinson's disease.

Apomorphine a dopamine receptor agonist was given subcutaneously to 57 levodopa treated parkinsonian patients with refractory off-period disabilities for a median period of 16 months. In 30 given intermittent suprathreshold injections the mean number of hours spent in a disabling off state fell from 6.9 to 2.9. Similar benefit was observed in 21 patients receiving continuous infusions with additional boluses on demand by mini-pump (mean reduction of hours off from 9.9 to 4.5). Twelve patients have been treated for over two years without tachyphylaxis or loss of response. The incidence of neuropsychiatric side-effects has been low (7%). Six patients failed to show a sustained worthwhile response; severe disabilities during "on" periods being the major problem. Subcutaneous apomorphine is proposed as an effective treatment for patients with incapacitating "off" period disabilities refractory to oral medication and should be considered before experimental implantation procedures.

Adult↗
PubMed1989

Anal sphincter dysfunction in Parkinson's disease.

Striated anal sphincter function was studied electrophysiologically and radiologically in six patients with Parkinson's disease and chronic constipation. In five cases, there was paradoxic anal sphincter muscle contraction during simulated defecation straining resembling anismus-type pelvic outlet obstruction. Radiologic studies showed functional improvement of the defecatory mechanism following the administration of the dopamine receptor agonist apomorphine in four patients. Dysfunction of the striated anal sphincter musculature may be a significant cause of constipation in some parkinsonian patients, occurring as part of the generalized extrapyramidal motor disorder.

Anal Canal↗
PubMed1989

Off-period belching due to a reversible disturbance of oesophageal motility in Parkinson's disease and its treatment with apomorphine.

Two L-dopa-treated patients with Parkinson's disease who developed distressing belching during "off" periods are reported. In each case, contrast cine radiography revealed disturbed oesophageal motility which disappeared after injection of the dopamine receptor agonist apomorphine. It is suggested that central dopaminergic abnormalities may be important in the aetiology of "off period belching."

Aged↗