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R P Kleyweg

Publications and source records attributed to R P Kleyweg.

16 recordsLinked to original sources
PubMed2000

Organic syndromes diagnosed as conversion disorder: identification and frequency in a study of 85 patients.

BACKGROUND: The percentage of patients initially diagnosed with a conversion disorder and later identified as having an organic disorder has been decreasing in recent studies. METHOD: Consecutive patients with a diagnosis of conversion disorder were referred for psychiatric diagnosis and treatment. Research questions were: (1) What incidence of neurological disorder is revealed by neurological reassessment and by which diagnostic technique is the final diagnosis established? (2) What differences can be observed between true-positive and the false-positive results? RESULTS: Ten (11.8%) of the 85 patients examined appeared to suffer from a neurological disorder. In this sample, variables discriminating between the true positives and false positives were: (1) prior suspicion of neurological disorder; (2) older age at referral; (3) older age at onset of symptoms; (4) longer duration of symptoms; and (5) use of medication. Three variables contributed significantly to the prediction of organic disorder: prior suspicion of neurological disorder; age at onset of symptoms; and duration of symptoms. CONCLUSIONS: Although our results are in line with those of other recent studies, the percentage of false positives was still high. The data further emphasize the dangers of making a diagnosis of conversion disorder in the absence of positive evidence. It is important to continue to provide follow up for patients with a diagnosis of conversion disorder. Unfortunately, unreliable psychiatric indications, like certain behavioral characteristics, are still used in the diagnostic process. The results show that a general neurological examination is still a valuable diagnostic instrument in addition to modern diagnostic techniques.

Adolescent↗
PubMed1998

Significant reduction in post-lumbar puncture headache using an atraumatic needle. A double-blind, controlled clinical trial.

A characteristic headache occurs in about 36-55% of patients after lumbar puncture, and many of these patients need bed rest for one or more days to get relief. In a double-blind randomized trial we compared a new 22-gauge atraumatic puncture needle with the most widely used 20-gauge "conventional" needle. In 49 patients randomized to the atraumatic needle, post-lumbar puncture headache occurred in 6%, whereas in the 50 patients randomized to the conventional needle this occurred in 32% (p = 0.001). On the basis of these results we recommend use of the atraumatic needle in order to diminish the frequency of post-lumbar puncture headache.

Adult↗
PubMed1996

Liver function disturbances in Guillain-Barré syndrome: a prospective longitudinal study in 100 patients. Dutch Guillain-Barré Study Group.

In 100 consecutive patients with Guillain-Barré syndrome, we assessed liver function on admission and at fixed intervals after either intravenous immunoglobulin (IgIV) or plasma-exchange (PE) treatment. On admission, 38% showed a plasma alanine aminotransferase elevation, gamma glutamyl transferase elevation, or both or more than 1.5 times the upper limit of normal. Ten of these patients had serologic evidence of recent cytomegalovirus infection. The remaining 28 patients were negative for other known causes of liver damage, including infection with Epstein-Barr virus or hepatitis A, B, and C; alcohol abuse; hepatotoxic drugs; recent surgery; and concurrent liver disease. In a hospital control group of 100 consecutive patients with subarachnoid hemorrhage, only 5 had unexplained liver function disturbances on admission (p < 0.0001). In the IgIV-treated group, the percentage of patients with elevated liver function tests increased from 35% before to 69% shortly after treatment at 2 weeks postadmission (p < 0.005). In the PE-treated group, this percentage decreased somewhat from 41% to 36% (not significant). There was also a significant rise in median plasma activity of the various liver enzymes in the IgIV group. At 1 month, however, significant difference had disappeared. At 3 and 6 months, the percentage of patients with liver function disturbances reached a significantly lower level in both treatment groups compared with the time of admission. We concluded that many patients with Guillain-Barré syndrome had mild liver function disturbances without obvious cause. In addition, IgIV treatment was associated with mild transient liver function disturbances through an unknown mechanism.

Humans↗
PubMed1995

[Less headache following lumbar puncture with the use of an atraumatic needle; double-blind randomized study].

OBJECTIVE: To investigate the difference in frequency of headache after lumbar puncture with a standard needle or an atraumatic needle. DESIGN: Prospective, randomised double blind study. SETTING: Department of Neurology, Merwedeziekenhuis, Dordrecht. METHOD: One hundred sequential patients were randomised to lumbar puncture with a 'standard needle' (20 gauge) or an 'atraumatic needle' (pencil point, 22 gauge). The patients were interviewed one week later. Patient and interviewer were unaware of the needle used. RESULTS: After puncture with the standard needle 32% of the patients suffered from postlumbar puncture headache, after use of the atraumatic needle 6% (p < 0.001; 95% confidence interval of the difference: 0.11-0.40). Postpuncture complaints appeared to be less severe after puncture with the atraumatic needle. CONCLUSION: In comparison with a standard needle, there is significantly less postpuncture headache after lumbar puncture with an atraumatic needle.

Adolescent↗
PubMed1995

Guillain-Barré syndrome without sensory loss (acute motor neuropathy). A subgroup with specific clinical, electrodiagnostic and laboratory features. Dutch Guillain-Barré Study Group.

We analysed data obtained from 27 out of a group of 147 patients with Guillain-Barré syndrome, who did not have sensory loss during a follow-up period of 6 months (motor Guillain-Barré syndrome). These patients had a distinctive clinical pattern compared with the other 120 Guillain-Barré syndrome patients. The clinical course was marked by a more rapid onset of weakness (3.9 versus 6.1 days, P = 0.002), an earlier nadir (6.3 versus 9.1 days, P < 0.001), an initially predominant distal weakness (67% versus 27%, P < 0.001), sparing of the cranial nerves (26% versus 68%, P < 0.001) and the disease was more often preceded by a gastro-intestinal illness (41% versus 13%, P = 0.001) often caused by a Campylobacter jejuni infection (67% versus 28% in the other Guillain-Barré syndrome patients, P < 0.001). High titres of anti-GM1 antibodies were also significantly more common in motor Guillain-Barré syndrome patients (42% versus 5%, P < 0.001). Electromyographic data of the motor Guillain-Barré syndrome patients at nadir revealed little or no evidence for demyelination. Abundant denervation activity was present in half of the patients. The response to immune globulin treatment was good but with plasma exchange significantly fewer motor Guillain-Barré syndrome patients reached the stage of independent locomotion after a follow-up period of 6 months especially if the acute motor neuropathy occurred after a C.jejuni infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

Axonal damage in Guillain-Barré syndrome.

In Guillain-Barré syndrome patients, severe axonal degeneration occasionally occurs, often resulting in permanent functional deficit. In order to assess the development of axonal degeneration, we followed a consecutive series of 42 patients longitudinally using clinical and neurophysiological methods. Eight patients were considered to have severe axonal degeneration: in these patients denervation potentials were eventually found and at least 1 nerve proved inexcitable, and clinical recovery was slow and incomplete. Five of these 8 patients initially showed a pronounced generalized conduction block, the physiological hallmark of demyelination, before signs of axonal degeneration developed. In the remaining three patients, the first evaluation revealed low amplitudes with only modest conduction block; this is consistent with predominantly distal demyelination, but might, alternatively, be explained by primary axonal degeneration. Caution is necessary in using distal CMAP parameters for prognostic purposes, because the distal CMAP may be relatively spared in the early phase of the disease despite severe axonal degeneration later.

Action Potentials↗
PubMed1991

In vivo effects of sera from Guillain-Barré subgroups: an electrophysiological and histological study on rat nerves.

Serum from 20 patients with Guillain-Barré syndrome (GBS), 10 healthy controls and 10 patients with recent cytomegalovirus, Epstein-Barr virus, or Campylobacter jejuni/coli infections was injected into rat sciatic nerve. The 20 GBS patients consisted of 2 groups of 10 patients with different electrophysiological and clinical disease patterns. The main aim of the study was to investigate possible differences in humoral (auto)-immunity between these subgroups. We found no statistically significant differences in electrophysiological or histological parameters between nerves injected with sera from the 2 GBS groups. The sera of the GBS groups caused significantly more compound muscle action potential reduction at 3 to 5 days postinjection than the healthy control sera. No significant difference in nerve conduction was found between nerves injected with GBS serum and serum of patients with proven infections without GBS. Histological analysis of the same nerves that were studied electrophysiologically showed no significant differences in demyelination or other histological parameters between patients and controls at 5 days postinjection. Based on the findings in this study that sera of GBS groups with important differences in disease pattern and sera of patients with proven infection but without GBS show similar in vivo effects on rat nerves, we suggest it may be more likely that these effects are caused by aspecific serum factors associated with immune-system activation, especially by precedent infections, than by specific disease-related factors such as anti-myelin antibodies.

Action Potentials↗
PubMed1991

Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome.

In studies of Guillain-Barré syndrome, functional deficit is usually assessed according to a functional scale consisting of several categories. The level of interobserver agreement in this scoring method is not known; furthermore, this method seems to be insensitive when applied to bedridden and artificially ventilated patients. We have developed an additional score (MRC-sumscore), reflecting muscle strength in general. Both scoring methods, tested in Guillain-Barré patients, have an almost perfect interobserver agreement. For the functional score kappa = 0.85, and for the MRC-sumscore r2 = 0.96. The MRC-sumscore is easily assessed and more sensitive than the functional score when patients are bedridden or artificially ventilated.

Humans↗
PubMed1991

Treatment related fluctuations in Guillain-Barré syndrome after high-dose immunoglobulins or plasma-exchange.

Since the introduction of plasma exchange as a treatment for Guillain-Barré syndrome (GBS) patients, treatment related fluctuations have been found to occur in about 10% of the patients. These fluctuations are considered additional evidence of the beneficial effect of plasma exchange. In this report the occurrence of such treatment related fluctuations is described in the 147 patients who took part in the Dutch Guillain-Barré trial comparing high dose intravenous immunoglobulin with plasma exchange. Six of 72 patients in the plasma exchange group and eight of 74 in the immunoglobulin group showed such fluctuation. These results support the biological effect of immunoglobulin. More general use of immunoglobulin should await the full analysis of the Dutch GBS trial which is in progress.

Adolescent↗
PubMed1989

The natural history of the Guillain-Barré syndrome in 18 children and 50 adults.

Plasma exchange (PE) is indicated in adult patients with a severe Guillain-Barré syndrome (GBS). For children this has not been proven. If the disease runs a milder course in children, the problems experienced with PE might outweight the benefit. In order to evaluate the need for such a specific treatment in children, we compared the severity of the disease between 18 children and 50 adults; no significant differences were found. The mean duration of hospitalisation of all children was 84 days, four children needed artificial ventilation for a mean of 21.5 days and two children died. We conclude therefore that PE is indicated in children with a severe GBS. The final decision, however, depends also on the practical feasibility of the procedure.

Adolescent↗
PubMed1988

Treatment of Guillain-Barré syndrome with high-dose gammaglobulin.

Intravenous gammaglobulin (IVGG) can improve the clinical course of several immune-mediated diseases. We report the first results of such treatment in eight patients with severe Guillain-Barré syndrome (GBS). We observed that IVGG was beneficial in at least some of the patients with severe GBS. These results should be confirmed in a randomized trial.

Adult↗