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Biomedical subjects

R G Beran

Publications and source records attributed to R G Beran.

At least 19 recordsLinked to original sources
PubMed1992

Chromosome fragility in the Lennox-Gastaut epilepsy syndrome.

Chromosome fragility was sought in a well-defined cohort of patients with Lennox-Gastaut epilepsy syndrome. Twenty-five patients plus 25 age- and sex-matched normal controls had cytogenetic studies performed. All patients were taking sodium valproate, and four were also on hydantoin. Blood cultures from both patients and controls were set up simultaneously in an appropriate medium designed to elicit fragile-sites. Harvesting took place after 96 h by standard techniques. In addition to routine banded analysis, at least 50 cells were scored for chromosome breaks and gaps from each patient and control. Results showed no difference between the patients and the control group in the overall occurrence of fragility or the type of aberration detected. No fragile-X syndrome was detected. This study found no effect due to sodium valproate on the occurrence of chromosome aberrations.

Adolescent↗
PubMed1992

Automatisms--the current legal position related to clinical practice and medicolegal interpretation.

The interface between medicine and the law is an area which demands further investigation. There can be no criminal capability for an act unless the perpetrator had both the will to so act and the capacity to differentiate and choose whether or not to conform the particular behaviour to that dictated by the law. The capacity for choice must remain the fundamental issue. The range of conditions which can raise volition as a defence include: Somnambulism; post-traumatic syndromes; epilepsy; arteriosclerosis; or acts secondary to cerebral neoplasia. There is need to differentiate between reflex actions and automatisms and it is imperative that terms such as automatism or automatic behaviour are not perverted to allow an excuse for that which is inexcusable. Cases such as that of Cogdon, who was acquitted of murdering her daughter; Ramsbottom who was found guilty of causing a traffic accident despite having a stroke; Dennison in which a driver was found guilty despite epilepsy or Jenkins where the driver was initially found innocent of dangerous driving because of the unpredictable nature of diabetes are discussed. Special attention will be focused upon the case of Sullivan, a landmark in consideration of automatism in epilepsy. The paper examines insane verses non-insane automatism and the Australian legal system as it affects modern neurological practice. Suggestions are proffered as to how the law should be modified to better reflect justice as required within the context of modern medical knowledge. 'The social and psychological pressures that shape our criminals also shape-those who make and remake the laws which aim to control, punish or rehabilitate them, and those who try to change their behaviour.'

Australia↗
PubMed1991

Neuropsychological assessment in lamotrigine treated epileptic patients.

A double-blind, placebo controlled cross over study assessed the efficacy of lamotrigine as adjunct therapy for patients with refractory partial seizures. In addition to the main study, a neuropsychological component evaluated three main areas of cognitive function. These included: i) Concentration and attention; ii) General Cerebral Efficiency, and iii) Mnestic functions--immediate, short term and new learning ability. Ten subjects (4 males, 6 females, age range 22 to 53, mean age 31.3 years) were involved in the study, each assessed 3 times--baseline, end of phase I and end of phase II. Whilst statistical analysis proved impracticable due to differing scores across cells, between the results of lamotrigine and placebo, clinically, there appeared to be a marginal reduction in General Cerebral Efficiency during the lamotrigine phase. In the light of these tests, the conclusion is advanced that lamotrigine does not specifically impair cognitive function, and that it does not impair mnestic function. An alternate hypothesis of interaction effects is posited for the slight reduction in speed of information processing.

Adult↗
PubMed1989

Medical management of epilepsy.

The treatment of epilepsy depends on an accurate diagnosis of the specific type of epilepsy. Where possible it is important to prescribe the minimum amount of medication for seizure control, preferably with monotherapy. The ultimate aim of treatment is to achieve maximal improvement in the quality of life for the patient.

Anticonvulsants↗
PubMed1988

The role of computed tomography in the assessment of neurologic sequelae of decompression sickness.

Computed tomographic (CT) scans were performed on 47 patients who had received recompression treatment for decompression sickness. A retrospective review of the case notes disclosed that 24 of the 47 patients had symptoms that suggested cerebral involvement. None of the reported CT abnormalities could be correlated with the clinical manifestations at presentation. It was concluded that the CT scan is not a cost-effective investigative tool for the posttreatment evaluation of decompression sickness.

Brain↗
PubMed1988

Sodium valproate.

Explore the source record for details and available documents.

Australia↗
PubMed1988

Neurologists' use and interpretation of antiepileptic drug monitoring in the treatment of epilepsy.

Of the 150 local Ordinary Members of the Australian Association of Neurologists (AAN), 118 responded to a questionnaire on the use of AED level measurement in the management of epilepsy. AED level measurement is widely employed, but only phenytoin levels were accepted as being reliable by more than 90% of AAN members. Respondents questioned absolute reliance being placed on any of the other AED levels.

Anticonvulsants↗
PubMed1987

Clinical relevance of therapeutic drug level estimation with respect to clonazepam and carbamazepine: preliminary report.

This paper compares the results of plasma drug level estimations for 30 patients receiving clonazepam and 39 patients taking carbamazepine (assessing total and free carbamazepine concentrations together with carbamazepine epoxide levels) with the clinical features of seizure control. Owing to the small numbers of seizure-free patients, the power of the study was insufficient to justify absolute conclusions being drawn. However there appeared to be a trend which suggested that drug level estimations in both situations had virtually no clinical relevance. This causes one to question the growing reliance on plasma drug level estimation in the treatment of epilepsy and, because of the low power of the study, demands extension of the work to confirm its significance. This type of research in epilepsy, based exclusively on a secondary and tertiary referral source, has inherent difficulty in that a conspicuously low number of well controlled patients is included. Acknowledgement of this fact should lead one to appraise critically other papers giving dogmatic statements regarding therapeutic ranges of anticonvulsant plasma levels.

Adolescent↗
PubMed1987

Evaluation of the first 18 months of a specific rehabilitation programme for those with epilepsy.

This survey examined the outcome of the first 18 months of the specialized rehabilitation programme at Mt Wilga Rehabilitation Centre, which was designed to cater for the needs of those with epilepsy. Almost 60% of those who underwent the programme were employed at the time of the study, 65% had improved quality of life, approximately 45% acknowledged enhanced self-esteem, and about 45% had an improved control of epilepsy despite the fact that only 30% had their drug therapy altered and of these more than half had either the same or worse control of their seizures. The findings revealed that those patients who were admitted into the residential accommodation, rather than being provided with transport to allow daily attendance while living in their own homes, achieved greater benefit from the rehabilitative programme.

Adolescent↗
PubMed1985

An accurate assessment of the prevalence ratio of epilepsy adequately adjusted by influencing factors.

The prevalence of epilepsy was estimated by defining an initial prevalence ratio based on a population study and modifying this figure on the basis of various factors which influenced it. The definition required 3 seizures diagnosed by a doctor and the influencing factors included false-negative responses (where the diagnosis was confirmed), false reporting (where the diagnosis had not been established) and falsely low seizure counts (where therapy had reduced the number of seizure below the mandatory 3). As a result of these calculations the figure of approximately 1 in 50 was offered as a reliable and reasonable estimate of the true prevalence ratio of epilepsy within a well-defined Australian population.

Anticonvulsants↗