PubMed Health⌕ Search

Biomedical subjects

P Clough

Publications and source records attributed to P Clough.

14 recordsLinked to original sources
PubMed2005

The use of complementary medicines and alternative practitioners in a cohort of patients with epilepsy.

Complementary and alternative medicines (CAMs) are increasingly used by patients in the Western world. Some of the most popular herbal remedies are known to act on the cytochrome P450 system, with potential effects on antiepileptic drug (AED) levels. Few studies have explored their use in people with epilepsy. We surveyed 400 patients attending epilepsy clinics in Greater Manchester. Thirty-four percent of our patients had used or were using CAMs; the majority had not told their doctor. Use of CAMs was not predicted by age, sex, seizure frequency, number of AEDs, or dissatisfaction with conventional medicine. Patients who had gone onto higher education were significantly (P < 0.05) more likely to have used or be using CAMs. The majority of patients did not use CAMs for their epilepsy but for general health purposes. Most patients stated that CAMs had little or no effect on seizure frequency or severity.

Adult↗
PubMed2004

Reversible parkinsonism with normal beta-CIT-SPECT in patients exposed to sodium valproate.

After reports of reversible parkinsonism and cognitive impairment with sodium valproate (VPA), the authors examined 50 consecutive patients taking VPA and 20 patients taking carbamazepine. Three patients taking VPA exhibited unequivocal parkinsonism with Unified Parkinson Disease Rating Scale scores >30. VPA was withdrawn from two patients with improvement of symptoms. Reduction in VPA dosage in the third patient produced no improvement. beta-CIT-SPECT scans were normal, suggesting dopaminergic neuronal loss is not the underlying mechanism.

Adult↗
PubMed2000

Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause.

OBJECTIVES: We sought to investigate the value of cardiovascular tests to diagnose convulsive syncope in patients with apparent treatment-resistant epilepsy. BACKGROUND: As many as 20% to 30% of epileptics may have been misdiagnosed. Many of these patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy on clinical grounds. METHODS: Seventy-four patients (33 men, mean age 38.9 +/- 18 years [range 16 to 77]) who were previously diagnosed with epilepsy were studied. Inclusion criteria included continued attacks despite adequate anticonvulsant drug treatment (n = 36) or uncertainty about the diagnosis of epilepsy, on the basis of the clinical description of the seizures (n = 38). Each patient underwent a head-up tilt test and carotid sinus massage during continuous electrocardiography, electroencephalography and blood pressure monitoring. Ten patients subsequently underwent long-term electrocardiographic (ECG) monitoring with an implantable loop recorder. RESULTS: In total, an alternative diagnosis was found in 31 patients (41.9%), including 13 (36.1%) of 36 patients taking an anticonvulsant medication. Nineteen patients (25.7%) developed profound hypotension or bradycardia during the head-up tilt test, confirming the diagnosis of vasovagal syncope. One other patient had a typical vasovagal reaction during intravenous cannulation. Two patients developed psychogenic symptoms during the head-up tilt test. Seven patients (9.5%) had significant ECG pauses during carotid sinus massage. In two patients, episodes of prolonged bradycardia correlated precisely with seizures according to the insertable ECG recorder. CONCLUSIONS: A simple, noninvasive cardiovascular evaluation may identify an alternative diagnosis in many patients with apparent epilepsy and should be considered early in the management of patients with convulsive blackouts.

Adolescent↗
PubMed1999

Accurate diagnosis of convulsive syncope: role of an implantable subcutaneous ECG monitor.

Convulsive syncope due to transient bradycardia is recognized as a cause of treatment-resistant seizures. However, the diagnosis may be difficult to make with conventional electrocardiographic devices if attacks are infrequent. We present a case of apparent epilepsy in which a new implantable electrocardiographic event recorder (the 'Reveal' insertable loop recorder) was used to show that attacks were caused by prolonged asystole of up to 36 s in duration. The insertable loop recorder may have an important role in the investigation of patients with treatment-resistant seizures, particularly where there is a strong suspicion of an underlying cardiac arrhythmia.

Adult↗
PubMed1999

Head-up tilting is a useful provocative test for psychogenic non-epileptic seizures.

Differentiating psychogenic non-epileptic attack disorder (NEAD) from true epilepsy is difficult. This often results in a misdiagnosis and unnecessary and ineffective treatment. Prolonged EEG/video recording is the most sensitive tool for differentiating NEAD from epilepsy, but is costly and therefore limited in availability. Provocative tests, particularly the use of saline injection, can reduce the length of monitoring but give rise to ethical dilemmas. This study assesses the value of head-up tilt testing as a provocative test for NEAD. Twenty-one patients (17 female, mean age 34.6 +/- 11.5 years) with recurrent seizure-like episodes and a clinical diagnosis of NEAD were studied. Patients were tilted to 80( composite function )on an electric tilt table with footplate support for up to 45 minutes during continuous ECG, EEG and blood pressure monitoring. Seventeen patients (81%) experienced typical symptoms (non-epileptiform limb shaking in 15 patients, absence in one patient, myoclonic jerking in one patient) during head-up tilt without significant EEG abnormalities or haemodynamic changes. The mean time to onset of seizure-like activity was 13.2 +/- 11 minutes (range 0-31 minutes). No patients suffered injury or any other significant side-effect. Provocative testing using suggestion and head-up tilt is a sensitive tool for diagnosing NEAD and represents a safe, simple and inexpensive outpatient technique for investigating patients with suspected NEAD.

Adult↗
PubMed1998

The misdiagnosis of epilepsy: findings of a population study.

This paper reports the results of a population study designed to assess the standards of epilepsy care within a geographical population in relation to diagnosis, seizure management and quality of life. One of the findings was the unexpectedly high frequency of the misdiagnosis of epilepsy. Forty-nine of 214 patients with a primary diagnosis of epilepsy were subsequently found to have been misdiagnosed following a specialist review and investigations. All except two have been withdrawn from antiepileptic medication. The diagnosis of epilepsy was disputed in a further 26 patients. Of the 49 patients, 20 were found to have cardiovascular or cerebrovascular pathology. Seven had only ever experienced a single seizure and a further 10 were found to have underlying psychopathology. Such observations support the view that epilepsy is frequently misdiagnosed and this paper discusses some of the implications of misdiagnosis.

Adolescent↗
PubMed1998

Midazolam via the intranasal route: an effective rescue medication for severe epilepsy in adults with learning disability.

People with a learning disability are often disadvantaged due to the nature of their disability. Up to a third are likely to have concomitant epilepsy which adds to the health loss experienced by this group. It is important to manage their epilepsy in such a way as to limit the debilitating effects of both the illness and the medication. Rectal diazepam remains the gold standard rescue medication for prolonged, recurrent seizures or seizures associated with hypoxia. Some of the drawbacks are highlighted in this paper and we go on to explore a novel means of treating these seizures. Midazolam, via the intranasal route, has been used extensively in children, mostly as a sedative but also in the treatment of epilepsy. We present two cases, both are adults with a learning disability, who have benefited significantly from the use of intranasal midazolam. Ongoing research into the safe use of this form of treatment, training of staff and carers and the impact on the individual is being conducted.

Administration, Intranasal↗
PubMed1987

Method for individualizing patient care for chronic obstructive pulmonary disease patients.

Chronic obstructive pulmonary disease is a progressively debilitating disease that affects not only the patient's physical capabilities, but the patient's entire psychosocial network, including family and friends. A patient education program has been developed to assist each patient individually in dealing more effectively with all aspects of care.

Adaptation, Psychological↗
PubMed1986

Guidelines for routine respiratory care of patients with spinal cord injury. A clinical report.

Pulmonary compromise is a leading cause of morbidity in patients with spinal cord injury (SCI). Because these patients have such complex and massive needs, routine respiratory care is not always given the priority it deserves in a rehabilitation program. Our institution established a committee to formulate guidelines for the routine respiratory care of patients in our interdisciplinary Acute Spinal Cord Injury Program. The guidelines consisted of evaluation, treatment, and teaching interventions. The purposes of the guidelines were to increase staff awareness of the need for routine, prophylactic respiratory care of patients with SCI; to be an effective teaching tool for staff, thus resulting in a reduction of respiratory complications; and also to be a teaching tool for patients and their families so that routine respiratory care could be continued in the home. After using the guidelines for over a year, we believe that the quality of the respiratory care we provide our patients with SCI has improved. The respiratory care is more comprehensive, consistent, and coordinated among disciplines.

Acute Disease↗
PubMed1983

Glossopharyngeal breathing: its application with a traumatic quadriplegic patient.

Quadriplegic individuals have compromised ventilatory capacities as measured by pulmonary function tests. This compromise may put them at increased risk for pulmonary complications. Glossopharyngeal breathing (GPB) was a technique commonly used in the 1950s with poliomyelitis patients to enhance their breathing capabilities. This same technique can be used with quadriplegic individuals to improve their forced vital capacity (FVC). Increasing quadriplegic individuals' ventilatory ability can help decrease the risk of pulmonary complications and therefore increase their independence.

Adolescent↗